Clonal similarities and sequence-type diversity of invasive and carriage Streptococcus pneumoniae in India among children under 5 Years

Background: Pneumococcal pneumonia is one of the major causes of mortality in children less than 5 years in Asia, especially in India. Available PCVs have less serotype coverage in India compared to western countries. Moreover, the baseline pneumococcal serotype and sequence type data is limited and available data doesn't represent the entire India. With this background we aimed to characterize invasive and carriage isolates of S. pneumoniae from a tertiary care hospital in South India. Materials and Methods: A total of 221 S. pneumoniae isolates, invasive (n=138) and carriage (n=83) between the time period of 2012-2018 were included. Isolates was identified and confirmed using standard laboratory protocols. Serotyping was performed by Customized sequential multiplex PCR and MLST as described in www.pubmlst.org. Results: The major serotypes were 19F, 6B, 14, 6A and 19A and the sequence types (ST) were ST63, 236 and 230. Predominant STs in invasive was ST 63 whereas in carriage were ST4894 and 1701. High level ST diversity in carriage was observed. Majority of the STs were SLVs or DLVs of previously reported STs or PMEN clones. Phylogenetic analyses of the STs revealed gradual expansion of three PMEN CCs CC320, 63 and 230. Conclusion: The vaccine serotypes were the predominant ones found to be associated with IPD, PMEN clones, new STs and antimicrobial resistance. Accordingly, PCV13 is expected to provide invasive serotype coverage of 75% in Indian children less than 5 years. This study provides baseline serotype and sequence type data prior to the introduction of PCV in South India.

Insights to the diphtheria toxin encoding prophages amongst clinical isolates of Corynebacterium diphtheriae from India

Diphtheria is a dreadful disease caused by Corynebacterium diphtheriae. Lysogenised bacteriophages carrying toxin gene in C. diphtheriae can make the strain toxigenic. However, such phage disseminates the toxin genes to other strains when it undergoes lytic phase. As little is known about the phage diversity in C. diphtheriae in India, the present study was undertaken to investigate the prophages integrated into the genome of 29 clinical isolates of C. diphtheriae using whole-genome shotgun sequencing. Amongst these isolates, 27 were toxigenic, while 2 were non-toxigenic strains. Of the 27 toxigenic strains, all harbored known phages carrying toxin gene and two other phages with unknown function. However, the two non-toxin strains did not harbour any of the phages in the genome. It is imperative to devise prevention strategies that hinder the dissemination of toxin by prophages, as it may increase the complications of diphtheria post-immunisation.

Keratoprosthesis: Current global scenario and a broad Indian perspective

Keratoprosthesis (Kpro) forms the last resort for bilateral end-stage corneal blindness. The Boston Type 1 and 2 Kpros, the modified osteo-odonto Kpro and the osteo-Kpro are the more frequently and commonly performed Kpros, and this review attempts to compile the current data available on these Kpros worldwide from large single-center studies and compare the indications and outcomes with Kpros in the Indian scenario. Although the indications have significantly expanded over the years and the complications have reduced with modifications in design and postoperative regimen, these are procedures that require an exclusive setup, and a commitment toward long-term follow-up and post-Kpro care. The last decade has seen a surge in the number of Kpro procedures performed worldwide as well as in India. There is a growing need in our country among ophthalmologists to be aware of the indications for Kpro to facilitate appropriate referral as well as of the procedure to enable basic evaluation during follow-ups in case the need arises, and among corneal specialists interested to pursue the field of Kpros in understanding the nuances of these surgeries and to make a judicious decision regarding patient and Kpro selection and more importantly deferral.

Radiolabeling, biodistribution and tumor imaging of stealth liposomes containing methotrexate

To study the utility of sterically stabilized liposomes (stealth liposomes) in tumor scintigraphy by studying its biodistribution and accumulation in target tissue after radiolabeling with Technetium-99m (99mTC). Conventional and Stealth liposomes were prepared by lipid film hydration method using methotrexate as model anticancer drug. Radiolabeling of the liposomes was carried out by direct labeling using reduced 99mTc. Experimental conditions for maximum labeling yield were optimized. The stability studies were carried out to check binding strength of the radiolabeled complexes. The blood kinetic study was carried out in rabbits after giving the labeled complex by intravenous administration through ear vein. The biodistribution studies were carried out in the Ehrlich ascites tumor (EAT) bearing mice after intravenous administration through tail vein, showed prolonged circulation in blood and significant increase in the accumulation in tumor for the sterically stabilized liposomes compared to the conventional liposomes. The gamma scintigraphic image shows the distribution of the stealth liposomes in liver, spleen, kidney and tumor. The study gives precise idea about the use of stealth liposomes in tumor scintigraphy and organ distribution studies.

Rare cause for short stature--Kallmann's syndrome--a case report.

Kallmann's syndrome is a neuroendocrine disorder, characterized by hypogonadotropic hypogonadism with hyposmia. We report a 27 year old male who presented with short stature and pain in the lumbar region. On detailed evaluation he had growth retardation, features of hypothalamic hypogonadism as evidenced by endocrimological tests and anosmia since birth. He had co-existent caries spine T10,T11 causing pain in the lumbar region-MRI brain showed normal olfactory pathway while the response to nasal stimulants was markedly attenuated. We present this case for its very care occurrence in the eastern part of the world and the typical feature being normal MRI brain with functional defect of the olfactory pathway.

Treatment of painful osteoarthritis of the knee with hyaluronic acid. Results of a multicenter Asian study.

Hyaluronic acid is a component of synovial fluid, in osteoarthritis (OA) and shows a change of property of hyaluronic acid especially its viscoelasticity causing degradation of the cartilage. Injection of hyaluronic acid into OA of the knee (Hyalgan 2 ml/wk for 4 doses) in international multicentres gave dramatic responses: decreased pain, increased mobility of the joint after 49 days of injections compared to a placebo (2 ml of normal saline) p<0.01.

Effect of cyproheptadine on glucose tolerance, serum insulin and structure of pancreatic islets in rats.

The effect of cyproheptadine (CPH) on glucose tolerance, serum immunoreactive insulin (IRI) and structure of pancreatic islets in albino rats has been studied. Hyperglycemia with glucose intolerance was observed after 10 days of administration of CPH (40 mg/kg, ip). There was insignificant change of fasting IRI after the treatment. Histological studies indicated degranulation and vacuolation of beta cells with enlargement of capillaries. Improvement in blood glucose, glucose tolerance and structure of islets with proliferation of small pancreatic ducts and cell cords were observed 10 days after the withdrawal of CPH.

Reaction time in clinical diabetes mellitus.

Visual and auditory reaction times were studied in patients suffering from diabetes mellitus and age matched normal control subjects. Auditory reaction times were shorter than visual reaction times in control subjects as well as diabetic patients. In diabetic patients, there was significant prolongation of visual as well as auditory reaction times. Further studies of reaction times for various modalities may provide a better insight into the neurological disturbances in diabetes mellitus.

Effect of cigarette smoking on leucocytes in South Indians.

A study was done on 200 male hospital employees of similar socio-economic status in the age group of 25-45 years. The smokers had a significantly higher total leucocyte count and there was a significant positive correlation (r = 0.388) between the quantity of cigarettes smoked and leucocyte count. Besides this a significant lymphocytosis and neutropenia was also observed. It is suggested that total leucocyte count may be taken as an index for the degree of smoking.

Toxic and antigrowth effects of raw and processed field bean (Dolichos lablab) on albino rats.

Samples of freeze dried green field bean (Dolichos lablab) and dry mature bean, were subjected to the following processing methods—heat processing, extraction with 80% ethanol, hexane or dilute acid, protein isolation; and these samples were evaluated for growth promoting value and toxicity. Extraction with 80% ethanol or with dilute acid increased survival period of the animals; but these did not promote growth. Heat processing was essential to destroy antinutritional factors and promote growth. Extraction of the beans with 80% ethanol did not however alter the trypsin inhibitor or haemagglutinin activities. The protein isolate and acid-extracted residue which had low trypsin inhibitor and haemagglutinin activities, did not also promote growth. Thus the trypsin inhibtor and haemagglutinin activities did not completely account for the toxicity to albino rats. However, heat processing of ethanol extracted bean flour indicated that the beneficial effect of ethanol extraction was not apparent, once the samples were heat processed. Dry mature bean dhal was more toxic than the whole bean either dry or green. Supplementation of heat processed field bean with methionine and tryptophan promoted good growth of albino rats and significantly increased the protein efficiency ratio.