Clinical patterns of congenital ocular anomalies in the pediatric age group (0 to 5 years) and its association with various demographic parameters

Purpose: Congenital ocular anomalies are rare but important cause of childhood blindness. This study aimed to observe the clinical patterns of congenital ocular anomalies in the pediatric age group (0 to 5 years) and its association with various demographic parameters. Methods: Hospital?based cross?sectional study done on all pediatric patients in the 0?to?5?year age group presenting with congenital ocular anomalies to the Ophthalmology department of a tertiary care hospital in Eastern India between October 2018 and October 2020. Thorough clinical history was obtained, and comprehensive ocular examination was done in each case. Results: A total of 5686 patients in the 0 to 5 years age group attended the eye OPD during the study period. Congenital ocular anomalies were seen in 140 patients. The prevalence of ocular anomalies was 2.46%. Average age of patients was 3.32 ± 1.42 years. There were 74 (52.9%) males and 66 (47.1%) females. Unilateral and bilateral involvement was seen in 100 (71.45%) and 40 (28.6%) cases, respectively. Antenatal period was uneventful in 92.14% cases. Decreased vision was the most common presentation (40%). Congenital nasolacrimal duct obstruction was the most common anomaly seen in 29 (20.71%) cases followed by congenital cataract in 21 (15%) cases. Conclusion: Few of the congenital ocular anomalies can be prevented by increasing community awareness. Findings of the study can act as a reference guide for clinicians and health professionals for counseling and health planning.

Uncontrolled per rectal bleeding in chronic myeloid leukaemia: a mere coincidence or a dangerous sign report of an unusual case

Bleeding haemorrhoids present commonly to surgical outpatient departments (OPDs) and sometimes in emergency. Most often conservative management suffices but infrequently the patients can land up in emergency operation theatre for uncontrolled bleeding. Some haematological disorders can also present with rectal bleeding and amongst them Chronic myeloid leukaemia (CML), a haematological malignancy, presenting as bleeding per rectum has been not been reported so far, though instances of CML with gingival bleed, epistaxis have been reported. CML per se is known to be asymptomatic (40% cases) and bleeding is rarely seen. Here we present an interesting case of an emergency hemorrhoidal bleed that was subsequently diagnosed as CML. The patient after failed conservative management for bleeding haemorrhoids was taken up for emergency haemorrhoidectomy and again a relook under general anaesthesia in the post-operative period as he continued to ooze. The total leucocyte counts which were initially high continued to rise further and the bone marrow examination was reported as chronic myeloproliferative neoplasm and the excised mass was consistent with haemorrhoids. Rectal bleeding associated with CML is so far unreported even though bleeding is seen due to platelet dysfunction from gums and nose in chronic phases of the disease. A high index of suspicion is needed particularly with deranged haematological parameters for considering a diagnosis of these rare presentations. and anaesthesia.

Incidence and management of intestinal perforation in typhoid: a prospective, observational study

Background: Intestinal perforation is a common surgical problem, which need proper attention. Typhoid is the most common cause of bowel perforation. With the concept of a correct diagnosis of perforation in reference to its etiology and further study of etiological factor (typhoid) in relation to epidemiology, surgical treatment and outcome, the present study has been undertaken.Methods: It is a prospective, observational study in which 50 cases of enteric perforation admitting in SMS Hospital at JAIPUR were observed. All patients of enteric perforation peritonitis were evaluated by detailed history, clinical examination and radiological as well as laboratory investigations. After initial resuscitation patient were treated by operative procedures. Postoperatively progress report, morbidity and mortality data were observed.Results: Mean age of patients was 26.38 years. Male to female ratio was 4:1. Enteric perforation is more common in patients with poor nutritional status and rural area. Primary repair of perforation was done in patient with small perforation with relatively healthy bowel, while ileostomy was done in patients with large perforation of longer duration, multiple perforations and edematous bowel with necrotic patches. Mortality was highest in patients who underwent primary repair and proximal loop ileostomy (33.3%) and lowest in patients in which exteriorization of the perforation as loop ileostomy was done (10.3%).Conclusions: The time interval between occurrence of perforation and starting of specific therapy is the most important factor in deciding the ultimate outcome of the typhoid perforation patient and operative procedure is another important factor in deciding the outcome.

Safety and efficacy of percutaneous nephrolithotomy in paediatric age group: our 3 year experience in Western Rajasthan

Background: Percutaneous nephrolithotomy (PCNL) has become a well-established procedure for the management of pediatric renal calculi. Paediatric PCNL has been performed using both adult and paediatric instruments. Objectives: To evaluate the safety, efficacy and complications using the Modified Clavien scoring system (MCSS) in children undergoing PCNL using adult sized instruments.Methods: All patients less than 16 years old were analyzed retrospectively in Western Rajasthan undergoing PCNL procedure at Dr. SN Medical College and Hospital from April 2016 to March 2019. All PCNL procedures were performed in prone position under general anaesthesia with fluoroscopic guidance and using adult size instruments. All the demographics, surgical data and perioperative information were collected.Results: Total 112 patients with 120 renal units (8 patients with bilateral stones), (66 boys and 46 girls), with a mean (range) age was 10.01±4.02 (2-16) years. The mean (range) stone size in our study was 28.94±1.10 (20-50 mm). Overall, stone-free rate after PCNL was 95%. Twenty five (25) children (20.8%) had operative complications; 23/25 (92%) had, Clavien grade I in 15 (60%), grade II in 8(32%) and all managed conservatively. 2 patients had hydropneumothorax, managed with ICD tube. Stone size, operative duration and haemoglobin drop were significantly associated with complications on Univariate analysis (p<0.05).Conclusions: In paedriatric age group PCNL is considered safe with MCSS showing grade I and grade II complications in majority (92%) of patients.

Health care seeking behaviour of pulmonary tuberculosis patients in Jabalpur district, Madhya Pradesh

Background: Successful tuberculosis control requires specific behaviors from patients and health providers. Therefore, understanding behaviors is fundamental to design interventions to strengthen tuberculosis control programs, including communication interventions. The aim of this study was to assess the healthcare-seeking behavior of pulmonary tuberculosis (PTB) patients in Jabalpur district.Methods: Cross-sectional study was conducted among category I new sputum positive PTB patients identified from nine designated microscopy centres from November 2013 to October 2014. Calculated sample size of 135 with a multistage random sampling method was used. Student’s t-test and Chi-square test were used along with descriptive statistics.Results: Mean age of patients was 33.87 (14.3) years, males constituted 66.7%, 72.5% patients belonged to below class IV socioeconomic status. Cough was experienced by 91.1% subjects, followed by fever (69.6%). First action was consulting a health care provider (HCP) in 41.5% followed by self-medication (21.5%). It took two attempts for 76% of patients to reach a formal health care provider. Private health care providers were consulted as first choice among HCPs by 86.7% patients, initial diagnosis was made by them in 25.9% cases. Sixty-three percent of patients were not satisfied with care at government hospitals, 41.5% had not heard of tuberculosis before their diagnosis, 59.5% of patients got information about tuberculosis from their relatives suffering from it.Conclusions: Cough is the most common and earliest symptom responsible for seeking care in pulmonary tuberculosis. Government health facilities contribute maximum to diagnosis but private health facility is the first choice for initial consultation. Patients’ perception of suggestive symptoms needs to be changed.

Patient and health provider factors affecting diagnostic delays of pulmonary tuberculosis in Jabalpur district of Madhya Pradesh, India: a cross-sectional study

Background: Delay in diagnosis of pulmonary tuberculosis (PTB) causes patients to have more severe disease, more complications and lead to higher mortality with disease spread. The aim of the study was to estimate patient proportion having delayed diagnosis of PTB and to estimate patient’ and health providers’ delay and associated factors.Methods: This cross sectional study was conducted on sample of 135 new sputum positive PTB patients from nine designated microscopy centres of Jabalpur district. Data collected on modified world health organization questionnaire. The criterion for defining delay was formulated keeping in mind the Revised TB Control Programme algorithm for diagnosis of PTB in PTB suspects. Mann Whitney U and Kruskal Wallis tests were used (α=5%).Results: Mean age was 33.87 (14.3) years. Males constituted 66.7%. Proportion of diagnostic delay was 87.4%. Median patient and health care personnel (HCP) interval were 39 days (IQR 22-75) and 34 days (IQR 12-79) respectively. Factors significantly associated with patient delay were poor knowledge about TB, smoking, symptoms perceived non serious, first action with symptom onset, and mode of transport patient used to reach the nearest public health facility. Stigma didn’t affected patient interval. Factors significantly associated with health providers’ delay were first consultations with; a non-formal HCP, private health facility, non-allopathic practitioner; consultation with multiple HCP’s; living more than half an hour away from public health facility.Conclusions: Unacceptable high delay in diagnosis, more from patient side. More attempts at increasing awareness are needed.

Assessment of core capacities for antimicrobial stewardship practices in indian hospitals: Report from a multicentric initiative of global health security agenda

Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.

Association of TP53 gene codon 72 polymorphism with incidence of cervical cancer in Chhattisgarh

TP53 gene encoding polymorphisms is a risk allele in terms of carcinogenesis. Here, we studied the risk assessment and association of TP53 to understand the cancer biology and behaviour in cervical cancer patients and possible anticancer drug development interfering with p53 protein production. TP53 gene encodes a central protein of apoptosis pathway p53 and its allelic variant has been postulated to play a vital role in carcinogenesis in addition to a variety of neurodegenerative disorders. We undertook a case control study, to examine the possible association of TP53 gene codon 72 polymorphism in leukocyte DNA from a total of 200 subjects (100 controls and 100 cases). TP53 codon Arg72Pro (rs1042522) genotype was identified using allele specific PCR and RFLP with statistical analysis using Vassar Stats (online). In Chhattisgarh population, individuals with GC and GG genotypes of TP53 gene codon 72 polymorphism has a significantly higher risk of cervical cancer (OR=6.36, 95%CI=2.8-14.03 and OR=7.42, 95%CI=3.5-15.9) as compared to CC genotype (OR=1) which was taken as reference. The 'G' allele was found to confer a significant risk of cervical cancer (OR= 3.69, 95%CI= 2.40-5.5) compared to 'C' allele. The present case control study demonstrated the prevalence of the Arg/Arg (GG) genotype in women with cervical cancer among Chhattisgarh population.

Common causes and trends of hepatocellular carcinoma at regional cancer centre Raipur, India

Background: Hepatocellular Carcinoma (HCC) is the most common primary malignancy of the liver and is the third most common cause of cancer related deaths in Asia-pacific region. Representative data on epidemiology of HCC in India is scanty and mostly from urban areas. It is more common in males then female. Hepatitis, alcohol consumption, aflatoxin and other hepatotoxins in diet are common causes. Authors did a study for the common causes and trends of the HCC registered at authors’ centre between January 2013 to November 2018.Methods: Authors analyzed their hospital data for the patient registered with the diagnosis of hepatocellular carcinoma at their centre during the study period for age, sex, number and causes.Results: Out of 23,766 patients registered for cancer in study period, 132 (0.55%) patients were of HCC, of which 89 (66.4%) were males and 43 (32.6%) were females, with ratio of 2:1. Commonest age group was between 50-59 years 46 (34.6%) followed by 40-49years 26 (19.5%). No patients were below 20 years of age. Among the commonest causes were alcohol consumption in 71 (53.4%), hepatitis B in 37 (27.8%), hepatitis C in 10 (7.5%), HIV in 4 (3%) and unknown in 11 (8.3%). There is rising trend in males and declining trend in females.Conclusions: Incidence of hepatocellular carcinoma is low among all cancer but has high mortality rate. Alcohol consumption and hepatitis were the commonest cause. It is common above 40 years specially in males.

Gemcitabine with carboplatin for advanced intrahepatic cholangiocarcinoma: A study from North India Cancer Centre

BACKGROUND: Gemcitabine plus cisplatin has been established as a standard chemotherapy regimen for advanced biliary tract cancers (BTCs) based on the phase III UK ABC-02 study, which included all types of biliary cancers. There is very limited data regarding the effectiveness of known chemotherapeutic regimens especially in IHCC. METHODS: Records of 63 patients diagnosis of IHCC who received Gemcitabine and Carboplatin (G-C Regimen) chemotherapy as a first line were retrospectively reviewed. The primary aim of this study was to assess the response rate of gemcitabine carboplatin-based chemotherapy as a first line therapy in advanced intrahepatic cholangiocarcinoma (IHCC). The secondary objectives were to assess toxicity, progression free survival and overall survival. RESULTS: There were 38 men and 25 women in our study with a median age of 56.75 years (range 31–78 years). Of the 38+25= 63 patients, 21 patients (33.8%) progressed, 5 patients (8.06%) had complete response, 25 patients (40.3%) had partial response, 12 patients (19.3%) had stable disease. Overall response rate was 48.36% and tumor control rate was 67.6%. Progression free survival was 5.3 months and overall survival of 10.3 months was seen. The most common grade 3–4 toxicities were anemia, neutropenia, and thrombocytopenia. Most common nonhematological toxicity was fatigue. CONCLUSION: Gemcitabine in combination with carboplatin has activity against advanced IHCC. Our results are comparable with other gemcitabine carboplatin studies as well as gemcitabine cisplatin-based studies.

Treatment of femoral shaft fractures in young children by Ender’s nail: indications & complications.

Background: Treatment of femoral fractures in age group of 6 – 12 years is controversial. Operative treatment is becoming better accepted. Various modalities of fixation include plate osteosynthesis, External fixation; Antegrade locked nailing, and flexible intramedullary nailing. Methods: 60 children aged 6-12 years (Average age – 8.2 years) with 66 femoral diaphyseal fractures (61 closed and 05 open) in 60 patients were managed with closed Ender’s nailing. Pathological fractures due to unicameral bone cyst were evident in 5 patients. Femoral shaft fractures at the level proximal to distal three fifth with canal diameter of ≥ 6mm were included in the study. Out of 66 traumatic fractures 42 fractures had stable pattern and 19 had unstable fracture pattern. The results were evaluated clinically and radiologically. Results: All the 42 stable femoral fractures showed bridging callus in a mean time of 3.83 weeks (2.5 to 6.5 weeks). Full weight bearing was possible in a mean time of 4.19 weeks. Radiological union was seen in a mean time of 9.4 weeks. 34 fractures were evaluated by scanogram one year after injury and they revealed lengthening of 0.3cms. All the children returned to their previous level of activities. All the 19 unstable femoral fractures showed bridging callus in a mean time of 5.53 weeks (4 – 8 weeks). Full weight bearing was possible in a mean time of 6.21weeks. Radiological union was seen in a mean time of 12 weeks. 8 patients were readmitted for adjunctive procedures like nail impaction, traction and cast immobilization. 20% patients with unstable group had shortening of 1.3cms and 20% had external rotation of lower limb. Conclusions: Ender’s nailing is simple, cost-effective and minimally invasive procedure in 6-12 years of age. It offers stable fixation with rapid healing. There is prompt return of child to normal activity.

Retrospective study on efficacy and safety of nanoparticle paclitaxel and concurrent radiotherapy in patients with advanced head and neck cancer.

Background: Advanced (Stage III and IV) Squamous Cell Carcinomas of the head and neck (SCCHN) produce severe functional impairment, considerable morbidity, and significant mortality. Over the past 2 decades, organ-sparing efforts using either induction chemotherapy or concurrent chemotherapy and radiotherapy (RT) have become popular and have demonstrated equivalent or superior survival rates compared with surgery and/or RT alone, with a survival rate of approximately 40% at 5 years. Although the addition of chemotherapy to RT enhances toxicity, randomized trials and meta analyses have documented improved survival clearly compared with the results from RT alone. Initially, most combinations included once-daily RT combined with cisplatin either alone or with 5-fluorouracil (5-FU). There was number of toxicities of high grades associated with these drugs, and also difficulty in their administration. We have retrospectively studied nanoparticle paclitaxel with RT on concurrent setting as an alternative. Methods: We have retrospectively studied data of patients of advanced SCCHN treated with nanoparticle paclitaxel along with RT. Nanoparticle paclitaxel was administered at a dose of 80 mg/m2 over one hour infusion once weekly along with RT, 60 Gray (Gy) in 30 fractions, five days per week, over 6 weeks. Results: Total numbers of patient in this study were 28 with median age of 49 years. 78.57% of patient had stage IV disease and 21.43% stage III. Overall response rate was 68% with complete response (CR) in 29% and partial response (PR) in 39%. Conclusions: The use of nanoparticle paclitaxel along with RT is safe, feasible, efficacious and cost effective. Intensive randomized studies with large sample size are required in this direction.

A Study on Facial Artery Variation and its Clinical Implication for Facial Surgeries.

Introduction: Accurate knowledge of the normal and variant arterial anatomy of the facial artery is important for vascular radiology and will provide an anatomical basis to assist surgeons in performing maxillo-facial surgeries successfully. Materials and Methods: Formalin-fixed faces of unknown sex adult cadavers were dissected following the Cunningham’s manual of practical anatomy, volume 3. The age of the cadavers was not noted. Results: The variations in the facial artery were grouped under three categories following the classification of Bayramet.al, 2010. Type I category – Facial artery terminated as angular artery ; Type II category – facial artery terminated as superior labial ; Type III – Facial artery terminated as inferior labial .In present study (type-II) is seen. Premasseteric branch was observed. Discussion: Niranjan NS (1988) observed the variations of facial artery in 50 hemi-faces. According to him, facial artery terminated as angular artery in 68 % of hemi-faces, lateral nasal artery in 26% of hemi-faces, Superior labial artery in 4% of hemi-faces and 2% terminated at the alar base 12. In present study facial artery terminates as superior labial artery. A study conducted by Magden et.al (2009) , on the premasseteric branch, suggested that in 3% cases the diameter of premasseteric branch was larger than the facial artery. Conclusion: This study shows that the variation in the branching pattern of facial artery variations, which help in avoiding the mishaps during certain surgical procedures.

<i>Cyclospora</i> infection among the school children of Kathmandu, Nepal: prevalence and associated risk factors

<b>Background</b>: The intestinalcoccidian protozoa <i>Cyclospora cayetanensis </i>has emerged as an important cause of parasitic diarrhea among the childrenliving in developing countries. This study aimed to determine the prevalence of <i>Cyclospora</i> among the school childrenof Kathmandu with relation to various associated risk factors. <b>Methodology</b>: A total of fivehundred and seven stool samples from students between the age group 3-14 years,studying in 13 different schools of Kathmandu were collected during the studyperiod (May- November, 2014) and processed in Public Health ResearchLaboratory, Institute of Medicine, Kathmandu, Nepal. A modified Acid Faststaining technique (Kinyoun’s method) was used to detect oocyst of <i>Cyclospora</i> from the formal-etherconcentrated stool samples. <b>Results</b>: <i>Cyclospora</i> was detected in 3.94% (20/507) of the stool samplesexamined. The prevalence was found to be highest among the students between theage group 3-5 years i.e. 10.15% (13/128), peaking during the rainy season(June-August). The detection rate of the parasite was found to be significantlyhigher (p<0.05) among the children presenting with diarrheal symptom,household keeping livestock(s) and consumers of raw vegetables/fruits withprevalence10.57 % (11/104), 10.11% (9/89) and 7.25% (14/193) respectively. <b>Conclusion: </b>Consumptionof untreated drinking water, fresh produce (raw fruits/vegetables) withoutproper washing and livestock presence at home were found to be some of thepredisposing factors for higher susceptibility of infection due to <i>Cyclospora</i>. This finding confirms apublic-health issue with potentially serious consequences whereby, children canbe infected through the exposure to oocyst contaminated food, water and getill.

<i>Cyclospora</i> Infection among School Children in Kathmandu, Nepal: Prevalence and Associated Risk Factors

Background: The intestinal coccidian protozoa <i>Cyclospora cayetanensis</i> has emerged as an important cause of parasitic diarrhea among children living in developing countries. This study aimed to determine the prevalence of <i>Cyclospora</i> among the school children of Kathmandu with reference to various associated risk factors.Methodology: A total of five hundred and seven stool samples from students between the age of 3–14 years, studying in 13 different schools in Kathmandu were collected during the study period (May–November, 2014) and processed at the Public Health Research Laboratory, Institute of Medicine, Kathmandu, Nepal. A modified acid fast staining technique (Kinyoun’s method) was used to detect oocyst of <i>Cyclospora</i> from the formal-ether concentrated stool samples.Results: <i>Cyclospora</i> was detected in 3.94% (20/507) of the stool samples examined. The prevalence was found to be highest among the students in the 3–5 year age group i.e. 10.15% (13/128), peaking during the rainy season (June–August). The detection rate was found to be significantly higher (p < 0.05) among children presenting with diarrheal symptoms, household keeping livestock and consumers of raw vegetables/fruits, showing a prevalence of 10.57% (11/104), 10.11% (9/89) and 7.25% (14/193) respectively.Conclusion: Consumption of untreated drinking water, fresh produce (raw fruits/vegetables) without proper washing and the presence of livestock at home were found to be predisposing factors for higher susceptibility of infection due to <i>Cyclospora</i>. This finding confirms the existence of a public-health issue with potentially serious consequences whereby children can be infected through exposure to oocysts in contaminated food and water and get ill as a result.

Are we requesting the right consent.

Medical treatment can only be administered with consent of a competent patient. Giving the treatment without consent is failure to respect patient’s autonomy; violating an individual’s right to self-determination. Methods: We conducted a cross sectional study to evaluate the consent forms from various hospitals. Consent forms of 372 out of 750 medical institutes in Nagpur were evaluated under 20 ethical and medico legal aspects of an ideal consent form. Results: Most of the consent forms lack important clauses of an ideal consent form that can go against the treating doctors in the court of law. Conclusions: Doctors need to be trained to design a consent form. They need to be made aware of the medico legal rights of the patient. The consent form is for the patients to acknowledge that the nature and purpose of treatment has been fully explained, understood and consented to. Remember patients never consent to doctor’s negligence but only to risks and complications.

Role of Decompression in Late Presentation of Cervical Spinal Cord Disorders

STUDY DESIGN: Prospective study conducted at Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India. PURPOSE: To show the efficacy of decompression in the late presentation of cervical spinal cord disorders. OVERVIEW OF LITERATURE: Studies by various authors have shown that early spinal decompression results in better neurological outcomes. METHODS: From January 2003 to January 2005, 11 of the 41 patients with cervical spinal cord compression, meeting the inclusion criteria, underwent anterior decompression; interbody graft placement and stabilization by anterior cervical locking plate. The neurologic and functional outcomes were recorded. RESULTS: Five patients had spinal cord injury and 6 patients had compressive cervical myelopathy. Complications included 1 death and 1 plate loosening. No patient lost their preoperative neurological status. One patient had no improvement, 2 patients showed full recovery. The mean follow-up is 28.3 month. At the of rehabilitation, 6 were able to walk without support), 2 could walk with support, and 1 needed a wheelchair. The average American Spinal Injury Association motor score on admission to the hospital, 32.8 (standard deviation [SD], 30.5); admission to rehabilitation, 38.6 (SD, 32.4); discharge from rehabilitation, 46.2 (SD, 33.7). The most recent follow-up was 64.0 (SD, 35.3). CONCLUSIONS: The anterior approach for cervical decompression allows for adequate decompression. This decompression is the best chance offered in even late reported cases, including posttraumatic cases where there is no evidence of cord transactions. The use of anterior cervical plates reduces the chances of graft loosening, extruding, or collapsing.

Lipidated promiscuous peptide augments the expression of MHC-II molecules on dendritic cells and activates T cells.

Background & objectives: In spite of the fact that BCG is the most widely used vaccine, tuberculosis (TB) continues to be a major killer disease in TB-endemic regions. Recently, many emerging evidences from the published literature indicate the role of environmental mycobacteria in blocking the processing and presentation of BCG antigens and thereby impairing with suboptimal generation of protective T cells. To surmount this problem associated with BCG, we constructed a novel lipopeptide (L91) by conjugating a promiscuous peptide consisting of CD4+ T-helper epitope of sequence of 91-110 of 16 kDa antigen of Mycobacterium tuberculosis to Pam2Cys, an agonist of Toll-like receptor-2. Methods: Mice were immunized subcutaneously with 20 nmol of L91, followed by a booster with 10 nmol, after an interval of 21 days of primary immunization. Animals were sacrificed after seven days of post-booster immunization. L91 induced immune response was characterized by the expression of MHC-II and CD74 on the surface of dendritic cells (DCs) by flowcytometry. Cytokines (IL-4, IL-10, IFN-γ) secretion and anti-peptide antibodies were measured by ELISA. Results: Self-adjuvanting lipopeptide vaccine (L91) was directly bound to MHC-II molecules and without requiring extensive processing for its presentation to T cells. It stimulated and activated dendritic cells and augmented the expression of MHC-II molecules. Further, it activated effector CD4 T cells to mainly secrete interferon (IFN)-γ but not interleukin (IL)-4 and IL-10. L91 did not elicit anti-peptide antibodies. Interpretation & conclusions: The findings suggest that L91 evokes maturation and upregulation of MHC class II molecules and promotes better antigen presentation and, therefore, optimum activation of T cells. L91 mainly induces effector Th1 cells, as evidenced by predominant release of IFN-γ, consequently can mount favourable immune response against M. tuberculosis. As L91 does not provoke the generation of anti-peptide antibodies, there is no fear of the efficacy of the vaccine being neutralized by pre-existing anti-mycobacterial antibodies in TB-endemic population. In conclusion, L91 may be considered as a future potential candidate vaccine against TB.

Potentialities of newly isolated Bacillus subtilis and Lactobacillus sp for curd preparation and a comparative study of its physico-chemical parameters with other marketed curds.

Two Bacillus sp. were isolated from the local fermented milk and identified on the basis 16S rRNA sequence profile as Bacillus subtilis AKL1 and by biochemical process as Lactobacillus acidophilus AKL2. These isolates were used as fresh inoculums for curd preparation individually and in combinations. Different physico-chemical and therapeutic properties of the newly prepared curd were examined and compared with marketed local (sweet and sour) and branded (Mother Dairy and Thackar) curds. The total hydrolyzed peptides, free amino acids, lactic acid were significantly higher, whereas, total solid, ash content, syneresis and free reducing sugar were lower in the curd prepared by a mixture of AKL1 and AKL2 (0.5:0.5, v/v). The antioxidant activity against ABTS+, DPPH•, OH• and Fe3+ were also higher in the newly formulated curd. Polyphenols (85.5µg/g), flavonoids (12.5µg/g) and free aromatic amino acids contents were also higher in AKL1+AKL2. All these components prevent excess protein oxidation that was revealed by SDS-PAGE. The curd also exhibited potent antimicrobial activity against some entero-pathogens like Clostridium perfringens, Escherichia coli, Shigella dysentery, Vibrio cholerae and Staphylococcus aureus. It can be concluded that the combination of these Lactobacillus sp. will be a fruitful inoculum for the preparation of curd having better health promoting effects.

The Lichen Genus Parmotrema in South Korea

Parmotrema A. Massal. is a common lichen genus scattered throughout the Korean Peninsula; however, no detailed taxonomic or revisionary study of this genus has been conducted for nearly two decades. Therefore, this study revised the taxonomy of this genus based on specimens deposited in the lichen herbarium at the Korean Lichen Research Institute and samples wereidentified using recent literature. In this revisionary study, a total of eighteen species of Parmotrema including eight new records [Parmotrema cetratum (Ach.) Hale, Parmotrema cristiferum (Taylor) Hale, Parmotrema grayanum (Hue) Hale, Parmotrema defectum (Hale) Hale, Parmotrema dilatatum (Vain.) Hale, Parmotrema margaritatum (Hue) Hale, Parmotrema pseudocrinitum (Abbayes) Hale, and Parmotrema subsumptum (Nyl.) Hale] are documented. Detailed descriptions of each species with their morphological, anatomical and chemical characteristics are also given and a key to the known Parmotrema species of the Korean Peninsula is presented.