Nerve conduction study in young children suffering from cerebral palsy

Objectives: Cerebral palsy (CP) is a motor impairment syndrome leading to disorders of movement and posture. Screening of electrophysiological parameters Hoffman reflex (H-reflex and nerve conduction velocities) becomes a necessary for the early detection and management of the disease. The study aimed to assess the various electrophysiological parameters of nerve conduction velocity in CP and age-matched normal children. Matrials and Methods: The present cross-sectional study was performed between children suffering from CP and healthy control. A total of 27 children of 12–24 months of age of either sex were examined. Among them, six children were normal (with age match), seven were diagnosed with spastic CP and remaining 14 children were diagnosed with hypotonic CP The electrophysiological parameters were recorded in the right lower limb (posterior tibial nerve-soleus muscle) of all children. Results: In electrophysiological parameters, H-reflex latency in secs values was significantly decreased in all CP children. The maximum amplitudes of reflexly excitable motor neurons (Hmax) (mV) and Hmax/maximum amplitude of motor response ratio in the gastrocnemius-soleus muscle were significantly increased in spastic CPas compared to control. H-reflex conduction velocity (HRCV) was significantly higher than motor nerve conduction velocity (MNCV) in hypotonic CP children. Conclusion: The electrophysiological parameters were altered in spastic CP children. The electrophysiological parameters in hypotonic CP were within range, indicating they did not suppress the neuronal motor pool. However, HRCV was significantly more than MNCV in hypotonic CP, suggesting some myelination process defect/white matter injury in motor neurons. We concluded that the electrophysiological parameters of the nerve conduction study are a reliable test for the assessment of tone of muscles in children. Thus, it may help in the early initiation of the treatment and therapies in CP children.

Evaluation of the Effect of Nonsurgical Periodontal Therapy on Malondialdehyde and 8-Hydroxy Deoxyguanosine Levels in Chronic Periodontitis

Background: Reactive oxygen species released on stimulation by periodontal pathogens cause oxidation of biomolecules and play significant role in periodontal disease pathogenesis. Aim: This study aimed to evaluate the levels of oxidative by?products malondialdehyde (MDA) and 8?hydroxy deoxyguanosine (8?OHdG) as biomarkers in chronic periodontitis patients compared to healthy as well as before and after nonsurgical periodontal therapy. The correlation between biomarkers and clinical attachment level was also evaluated. Settings and Design: A total of 112 subjects were included in this study. The subjects were divided into two groups (Group I included 56 healthy subjects and Group II constituted 56 chronic periodontitis patients) on the basis of clinical periodontal parameters. Materials and Methods: Group I subjects received no treatment and were evaluated once only for clinical and oxidative stress biomarker parameters. Nonsurgical periodontal therapy was carried out in Group II patients and they were evaluated at baseline and 3 months after therapy. Results: Both salivary and serum levels of MDA and 8?OHdG were found to be increased in chronic periodontitis patients as compared to healthy subjects. After nonsurgical periodontal therapy, the levels of MDA and 8?OHdG significantly reduced. Linear correlation between clinical attachment level and oxidative stress parameters was found to be positive and highly significant. Conclusion: It can be concluded that periodontal therapy is effective in improving the oxidative stress condition.

Prospective study on outcome and advantage of primary skin grafting in cases of avulsion scalp injury following trauma

Background: Traumatic avulsion injury poses severe risk as the overlying protective covering is lost and the raw tissue is exposed to the environment. Avulsion injuries involving the scalp are even more complicated to treat because of significant cosmetic concern involved. Aim of the study was to find a better solution than the existing method, we conducted a prospective study involving 13 patients with isolated traumatic scalp avulsion injury.Methods: This prospective study was conducted in Motilal Nehru Medical College and associated Swaroop Rani Nehru Hospital, Prayagraj,  after taking written and informed consents from the patients, between June 2017 and June 2019.These were divided into two groups (A and B) based on whether the underlying periosteum was intact or not.Results: Patients with intact periosteum (Group A) underwent primary thin thickness skin grafting within a few hours of their admission while the other group (Group B) was treated with a traditional conservative approach. We compared the results of both the groups and found that Group A patients not only had satisfactory graft uptake (≥85 TBSA) but also had significant decreased risk of infection, lesser hospital stay, overall decreased healthcare cost, better cosmoses and early return to routine activity.Conclusions: For the surgeon, this single step procedure is safe and technically easy. Thus this approach was found to be superior than the current traditional approach.

In vitro susceptibility of dermatophytes to oral antifungal drugs and amphotericin B in Uttar Pradesh, India

Background: Dermatophytosis is a major public health problem in our country. Although resistance to conventional oral and topical antifungal agents is being increasingly encountered, the sensitivity pattern of dermatophytes has not been systematically analysed. Aims: We aimed to determine the sensitivity pattern of dermatophyte isolates to amphotericin B and six oral antifungal drugs. Materials and Methods: Patients with dermatophytosis attending the outpatient department of dermatology were enrolled in the study. Samples were collected for mycological examination and in vitro antifungal sensitivity testing was done by broth microdilution as per the Clinical and Laboratory Standard Institute M38-A standards. Results: A total of 804 patients were enrolled. Specimens from 185 patients (23%) were both KOH and culture positive, and 44 of these isolates (41 Trichophyton mentagrophytes and 3 Trichophyton rubrum) were subjected to sensitivity testing. Minimum inhibitory concentrations (MIC) of itraconazole, ketoconazole, voriconazole and amphotericin B were comparable. The median MIC to fluconazole was higher than the other tested drugs. Dermatophytes were most susceptible to ketoconazole and voriconazole, followed by itraconazole, amphotericin B, fluconazole and griseofulvin. A high incidence of resistance was found to terbinafine and the difference was statistically significant in comparison to fluconazole, itraconazole, voriconazole, ketoconazole (P = 0.001) and griseofulvin (P = 0.003). The strains were more sensitive to amphotericin B as compared to griseofulvin (P = 0.02) and terbinafine (P < 0.001). Limitations: This was a hospital-based study and may not reflect the true pattern in the community. Only a few of the isolates were selected for study. The clinical response of patients, whose isolates were studied for in vitro sensitivity of the antifungals, was not studied. Conclusions: The sensitivity pattern of dermatophytes to various antifungals including amphotericin B, ketoconazole, voriconazole and itraconazole were determined. The studied isolates were least susceptible to terbinafine.

Resistance to anti leprosy drugs in multi-bacillary leprosy: A cross sectional study from a tertiary care centre in eastern Uttar Pradesh, India

Background: WHO MDT is the main drug regimen for treating leprosy and has been used for more than three decades. Many cases of relapse of leprosy have been reported, which points towards the emergence of drug resistance with the antileprotic drugs. Objectives: To find the resistance with the antileprotic drugs by detecting the mutations in drug resistance determining region of the rpoB, folP1 and gyrA genes of Mycobacterium leprae. Methods: Leprosy patients with bacterial index ≥2 were included in the study. The slides were further processed to extract genomic DNA, and polymerase chain reactions were performed to amplify the drug resistance determining region (DRDR) of rpoB, folP1 and gyrA genes. The samples in which genes could be amplified were subjected to DNA sequencing to detect mutations. Results: Out of 78 samples rpoB gene was amplified in 39 (50%), folP1 in 32 (41%) and gyrA in 45 (57.7%). In 20 (25.6%) samples no gene was amplified. Only 32 samples of rpoB, 25 samples of folP1 and 38 samples of gyrA gene were included in the study, rest were excluded due to sequencing error. No mutation was seen in rpoB gene and in folP1 gene. In gyrA gene samples mutations were seen in 8 (21%) samples, and were present at codon 91 GCA → GTA (Alanine → Valine). Limitations: Small sample size and less efficient method to detect resistance. Conclusion: Resistance is not a problem with conventional drugs in MDT. It is more common with quinolones.

Heat stable antimicrobial activity of Burkholderia gladioli OR1 against clinical drug resistant isolates.

Background & objectives: Drug resistant microbes are a serious challenge to human health. During the search for novel antibiotics/inhibitors from the agricultural soil, a bacterial colony was found to inhibit the growth of clinical isolates including Staphylococcus (resistant to amikacin, ciprofloxacin, clindamycin, clinafloxacin, erythromycin, gentamicin and methicillin) and Candida (resistant to fluconazole and itraconazole). The culture was identified as Burkholderia gladioli and produced at least five different antimicrobial compounds which were highly stable at high temperature (121°C) and in the broad pH range (3.0-11.0). We report here the antimicrobial activity of B. gladioli against drug resistant bacterial pathogens. Methods: The bacterial culture was identified using morphological, biochemical and 16S rRNA gene sequencing techniques. The antimicrobial activity of the identified organism against a range of microbial pathogens was checked by Kirby-Bauer's disc diffusion method. The antimicrobial compounds in the cell free supernatant were chloroform-extracted and separated by thin layer chromatography (TLC). Results: B. gladioli OR1 exhibited broad spectrum antimicrobial activity against drug resistant clinical isolates belonging to various genera of bacteria (Staphylococcus, Enterobacter, Enterococcus, Acinetobacter and Citrobacter) and a fungus (Candida). Based on TLC profile and bioautography studies, the chloroform extract of B. gladioli OR1 consisted of at least three anti-staphylococcal and two anti-Candida metabolites. The antimicrobial activity was heat stable (121°C/20 min) as well as pH stable (3.0-11.0). Interpretation & conclusions: The bacterial soil isolate, B. gladioli OR1 possessed the ability to kill various drug resistant bacteria and a fungus. This organism produced many antimicrobial metabolites which might have the potential to be used as antibiotics in future.

Yoga and Cognitive Behaviour Techniques for Academic Stress and Mental Wellbeing among School Students.

There are many stressors acting upon school children. Today in the era of increasing competitiveness,a child is overloaded with daily living stresses, and he lives a tight rope existence trying to cope up with the tremendous pressures from all institutions, whether it is school, family or society. These are resulting in various stress related ailments and psychological problems, which poses threat and challenges for the physical as well as mental wellbeing of the school going children. The present work was an attempt to measure one of the major source of stress,i.e. academic stress and mental wellbeing of a sample of school children and then to provide an intervention plan for a selected group of students who are having high academic stress and poor mental wellbeing. Certain specific Asanas, Mudras and Pranayams of Yoga were combined with some specific techniques of Cognitive Behaviour therapy (C.B.T.) to reduce the academic stress and to enhance the mental wellbeing of the selected group of school children. The results have shown a significant relief from academic stress and significant improvement in the mental wellbeing of these children. Detailed methodology and results are discussed in this paper. This paper highlights the efficacy of Yoga in combination with certain techniques of C.B.T. in enhancing overall wellbeing of school children.

A comparative study of disability in long stay patients versus Outpatients in a Psychiatric Hospital.

Background: Disability associated with mental illness is a major contributor to the global burden of disease. The present study was undertaken to assess and compare the disability in long stay patients versus outpatients in a psychiatric hospital using Indian Disability Evaluation Assessment Scale (IDEAS). Methods: Patients suffering from chronic mental illness included in the study. Indian Disability Evaluation Assessment Scale (IDEAS) was applied. Disability was assessed in these patients on all domains of IDEAS. Results: Majority of outpatients (n=13) had percentage of disability (<40%) compared to only 4 inpatients. Conclusions: IDEAS, a new instrument for quantifying and certifying disability in psychiatric patients is useful not only for the outpatients but also for inpatients. Chronic mental illnesses affect all areas of daily functioning, thus posing greater challenge for the rehabilitation of patients and their inclusion in the mainstream.

Proteomic analysis of heparin-binding proteins from human seminal plasma: a step towards identifi cation of molecular markers of male fertility.

Glycosaminoglycans, especially heparin, are involved in various cell processes such as apoptosis, cell cycle control, platelet activation, capacitation, acrosome reaction and sperm decondensation. Heparin-binding proteins (HBPs) are essential constituents of human seminal fl uid, which bind to sperm lipids containing the phosphorylcholine group and mediate the fertilization process. We utilized a proteomic set-up consisting of affi nity chromatography, isoelectric focusing (IEF) coupled with matrix-assisted laser desorption/ionization time-of-fl ight tandem mass spectrometry (MALDI TOF/MS) for protein analysis of human HBPs. We resolved 70 different spots on two-dimensional (2-D) gel and subsequently identifi ed these proteins. Forty different types of proteins were identifi ed. Functional analysis revealed that 38% of the proteins belonged to the enzyme category, 20% were involved in RNA processing and transcription, 18% in structure and transport function, and 16% in cell recognition and signal transduction. We also identifi ed 8% of proteins with unknown functions, although their expression in seminal fl uid has been documented. Proteins of seminal fl uid that bind heparin may be directly involved in sperm capacitation and acrosome reaction (AR), which are the two critical steps for fertilization. This information on HBPs would be useful for identifying potential biomarkers of fertility in the near future.

Group III PLA2 from the scorpion, Mesobuthus tamulus: cloning and recombinant expression in E. coli

Phospholipases A2 (PLA2) are enzymes that specifically hydrolyze the sn-2 fatty acid acyl bond of phospholipids, producing a free fatty acid and a lyso-phospholipid. We report the cloning and expression of a secretory phospholipase A2 (sPLA2) from Mesobuthus tamulus, Indian red scorpion. The nucleotide sequence codes for a 167 residue enzyme. The open reading frame codes for a 31 amino acid signal peptide followed by a mature portion of the protein. The primary structure shows the calcium binding motif, catalytic residues, 8 highly-conserved cysteines and C-terminal extension which classify it as a group III PLA2. The entire transcript was expressed in Escherichia coli and was purified by metal affinity chromatography under denaturing conditions. The protein was refolded by serial dilutions in the refolding buffer to its active form. Hemolytic assays indicate that the protein adopts a functional conformation. The functional requisites such as optimum pH of 8 and calcium dependency are shown. This report provides a simple but robust methodology for recombinant expression of toxic proteins.

Outcome of teenage pregnancy.

OBJECTIVE: The objective of the study was to evaluate the obstetric, fetal and neonatal outcomes of teenage pregnancy in a tertiary care teaching hospital. METHODS: A retrospective case control study was performed over a period of 5 years. Data were retrieved from hospital records. All teenage mothers (aged 13-19 completed years at delivery) delivering in the University Hospital were taken as cases. Next 3 consecutive deliveries in the age group of 20-30 year were selected as controls for each case. For statistical analysis the cases were further subdivided into 2 groups, 17 years (Group A) and 18 -19 years (Group B). Groups were compared for obstetric complications and neonatal outcome. Statistical analysis was done by software package SPSS 10. RESULTS: The incidence of teenage deliveries in hospital over last 5 years was 4.1%. Majority of the teenagers were primigravida (83.2% vs. 41.4%, p< 0.01). Complications like pregnancy induced hypertension (PIH) (11.4% vs 2.2%, p< 0.01), pre-eclamptic toxemia (PET) (4.3% vs 0.6%, p< 0.01) eclampsia (4.9% vs 0.6%, p< 0.01) and premature onset of labor (26.1% vs 14.6%, p< 0.01) occurred more commonly in teenagers compared to controls. Teenage mothers also had increased incidence of low birth weight (LBW) (50.4% vs 32.3%, p< 0.01), premature delivery (51.8% vs 17.5%, p< 0.01) and neonatal morbidities like perinatal asphyxia (11.7% vs 1.9%, p< 0.01), jaundice (5.7% vs 1.2%, p< 0.01) and respiratory distress syndrome (1.9% vs 0.3%, p< 0.05). Teenage pregnancy was also associated with higher fetal (1.9% vs 0.3%, p< 0.05) and neonatal mortality (3.8% vs 0.5%, p< 0.05). CONCLUSION: Teenage pregnancy was associated with a significantly higher risk of PIH, PET, eclampsia, premature onset of labor, fetal deaths and premature delivery. Increased neonatal morbidity and mortality were also seen in babies delivered to teenage mothers. Younger teenager group (17 years) was most vulnerable to adverse obstetric and neonatal outcomes.