Endoscopic Management of Vesicoureteral Reflux and Long-term Follow-up

Objectives: To report our experience with endoscopicmanagement of vesicoureteral reflux (VUR) by injection of atissue bulking substance – Dextranomer/ hyaluronic acid co-polymer at vesicoureteric junction.Design: Retrospective analyses of case records.Setting: Pediatric Surgery department in a tertiary caregovernment Institute.Participants: 500 children (767 renal units) consecutivelyreferred to the out-patient department with vesicoureteral refluxnoted on micturating cysto-urethrogram (MCU) over a period of13 years (2004-2016).Intervention: Preoperative VUR grading and renal scars onradionuclide scans were documented. Dextranomer hyaluronicacid copolymer was injected through a cystoscope at thevesicoureteral junction as a day care procedure under shortanesthesia. Patients were followed (average duration 27.3 mo)with clinical assessment, periodic urine cultures and renal scans.Main outcome measure: Cessation of VUR and symptomaticrelief / clinical success postoperatively at 3 months.Results: Complete symptomatic relief was obtained in 482(96.4%) patients. In 681 units where MCU was available, 614(90%) units showed resolution of VUR.Conclusion: Endoscopic injection of tissue bulking substancesat vesicoureteric junction to stop VUR seems to be an effectiveintervention

Cultural conditions on the production of extracellular enzymes by Trichoderma isolates from tobacco rhizosphere

Abstract Twelve isolates of Trichoderma spp. isolated from tobacco rhizosphere were evaluated for their ability to produce chitinase and β-1,3-glucanase extracellular hydrolytic enzymes. Isolates ThJt1 and TvHt2, out of 12 isolates, produced maximum activities of chitinase and β-1,3-glucanase, respectively. In vitro production of chitinase and β-1,3-glucanase by isolates ThJt1 and TvHt2 was tested under different cultural conditions. The enzyme activities were significantly influenced by acidic pH and the optimum temperature was 30 °C. The chitin and cell walls of Sclerotium rolfsii, as carbon sources, supported the maximum and significantly higher chitinase activity by both isolates. The chitinase activity of isolate ThJt1 was suppressed significantly by fructose (80.28%), followed by glucose (77.42%), whereas the β-1,3-glucanase activity of ThJt1 and both enzymes of isolate TvHt2 were significantly suppressed by fructose, followed by sucrose. Ammonium nitrate as nitrogen source supported the maximum activity of chitinase in both isolates, whereas urea was a poor nitrogen source. Production of both enzymes by the isolates was significantly influenced by the cultural conditions. Thus, the isolates ThJt1 and TvHt2 showed higher levels of chitinase and β-1,3-glucanase activities and were capable of hydrolyzing the mycelium of S. rolfsii infecting tobacco. These organisms can be used therefore for assessment of their synergism in biomass production and biocontrol efficacy and for their field biocontrol ability against S. rolfsii and Pythium aphanidermatum infecting tobacco.

Utility of whole‑cell repetitive extragenic palindromic sequence‑based PCR (REP‑PCR) for the rapid detection of nosocomial outbreaks of multidrug resistant organisms: Experience at a tertiary care center in North India.

Background: There is a huge need to develop molecular typing methods which are simple to perform, rapid and cost effective to confirm clonality of nosocomial isolates in outbreak situations. Objectives: The aim of the study was to investigate a hospital outbreak of multi-drug resistant (MDR) Klebsiellapneumoniae septicemia in a paediatric surgery intensive care unit (PSICU) using a repetitive extragenic palindromic polymerase chain reaction (REP‑PCR). Materials and Methods: MDR Klebsiella pneumoniae isolates from an outbreak of nosocomial sepsis were typed byREP‑PCR using consensus primers. Isolates from different intensive care units (ICUs) but with similar antibiogram were also genotyped for comparison. Results and Conclusion: A cluster of twelve MDR K Pneumoniae septicemia cases was identified at the PSICU by genotyping using REP‑PCR. Surveillance cultures failed to pick up any source of infection. REP‑PCR was found to be a rapid and simple tool for investigation outbreaks in hospitals. Due to early detection we could initiate infection control practices with focus on hand washing and prevent the further transmission of the organism.