Understanding Antimicrobial Resistance with perspective of One Health

The concept of "One Health" recognizes the intrinsic relationship among health of human, animal and environment as a whole. All facets of One Health are undermined by the irrational use of antimicrobials and AMR cannot be effectively contained without coordinated actions of all key stakeholders including community participation.

Preparation and Physicochemical Characterisation of Suryaprabha Gulika

Suryaprabha gulika is a Kharaleeya preparation mentioned in the Gulika prakarana of Sahasrayogam indicated for Sula, Swasa, Kasa and Mahajwara. It contains eleven ingredients namely Suddha Parada, Suddha Gandhaka, Suddha Hingu, Amalaki, Harithaki, Vibheethaki, Sunti, Pippali, Maricha, Yavani and Suddha Vatsanabha triturated for 6 hours in Jambeera swarasa. In this paper, the work done on pharmaceutical and analytical aspects of Suryaprabha gulika is detailed. Pharmaceutical study included Sodhana of Parada, Sodhana of Gandhaka, preparation of Kajjali, Sodhana of Hingu, Sodhana of Vatsanabha and the preparation of final product whereas the analytical study included evaluation of organoleptic characters, physico chemical parameters and analysis based on modern instrumentation techniques such as X-ray Fluorescence (XRF), X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM) and particle size analysis.

The Upper Esophageal Sphincter Distensibility Index Measured Using Functional Lumen Imaging Probe Identifies Defective Barrier Function of the Upper Esophageal Sphincter

Background/Aims@#The mechanism via which supra-esophageal symptoms are generated is unclear. We assessed upper esophageal sphincter (UES) function in novel fashion using functional lumen imaging probe (FLIP) topography. We hypothesize that symptoms related to aspiration of esophageal contents may be associated with a more distensible UES. @*Methods@#FLIP and reflux symptom index score data from patients undergoing diagnostic evaluation for an esophageal complaint over a 10-month period were analyzed retrospectively. UES distensibility on FLIP was studied at 40-70 mL volumes with in-depth analysis at 50 and 60 mL. Symptoms were compared between patients with low, middle, and high UES-distensibility index (UES-DI). Receiveroperating characteristic analysis was performed to determine associations between the UES-DI and individual reflux symptom index symptom item scores. @*Results@#One hundred and eleven subjects were included. Overall, the associations between UES-DI and symptoms that could be related to supra-esophageal aspiration were strongest at the 50 mL FLIP volume. Choking item score was highest in the high UES-DI group (2.8) vs 1.4 (P < 0.001) in the middle UES-DI and 1.1 (P = 0.004) in the low UES-DI groups. Similarly, the cough item score was highest in the high UES-DI group (2.7) vs 1.5 (P = 0.009) and 0.9 (P = 0.002) groups. @*Conclusion@#A higher UES-DI measures defective barrier function which could may be the main pathophysiology that generates supra-esophageal symptoms.

Impact of transition in socio-economic status on sonographically detected non-alcoholic fatty liver disease: a study based on modified Kuppuswamy classification in an urban population

Background: The transition in the socioeconomic status is associated with physical and mental challenges. The lifestyle modification is one of the key implicatory for this change. Non-alcoholic fatty liver is an ever-growing health concern. This study evaluates the socioeconomic categories based on Kuppuswamy classification and other correlated in sonographically detected Non-alcoholic fatty liver disease (NAFLD).Methods: This cross-sectional study was conducted on 300 sonographically detected NAFLD patients in the age group of 18-60 years. Detailed history, including the demographic profile, socio-economic status (Modified Kuppuswamy scale was followed for calculating the Socio-economic status of the family), occupation, dietary habits (vegetarian or non-vegetarian, exposure to junk food), drinking water supply, etc. Detailed assessment of the morphological parameters including the anthropometric measurements, height, BMI was also assessed.Results: The study finds 62 (41%) females and 88 (59%) males with NAFLD and 51-60 age group with maximum prevalence. Diabetes (63%), Soft drink consumption and obesity are important risk factors. New observation of our study is that amongst various Kuppuswami sociodemographic scales, the maximum patients belonging to Upper middle class and upper lower class presented with fatty liver.Conclusions: There is higher prevalence of NAFLD amongst males, diabetics, obese, soft drinks, tea and coffee consumers. Authors also find a unique correlate based on socio-demographic class of Kuppuswami scale. People belonging to upper middle class and upper lower class suffer from NAFLD more commonly than other sociodemographic classes.

Study of drug prescription pattern and adverse drug reaction monitoring in patients with hypertension and diabetes visiting outpatient department in a government tertiary care hospital in Maharashtra, India

Background: Drug utilization study is an important tool to study the clinical use of drugs and its impact on healthcare system. DUS in patients with HTN and DM is essential to observe the changing prescribing attitude of physicians with the aim to promote rational use of drugs and to minimize the adverse drug reactions.Methods: A cross sectional observational study was conducted on randomly selected patients attending medicine outpatient department in a tertiary care hospital. Drug prescription sheets of 600 patients were studied for 18 months from January 2016 to June 2017 and the prescribing pattern was analysed using the World Health Organization basic drug indicators.Results: Total 2029 drugs were prescribed to 600 patients that belonged to various classes. The average number of drugs prescribed per encounter was 3.4. Majority (61.5%) drugs were prescribed using generic names. Percentage encounters with the antibiotics and injections were 6.3 and 11.5 per cent respectively. 38% drugs were prescribed from the 20th edition of WHO Model List of Essential Medicines. PDD in the current study was found to be significantly less than WHO DDD in all drugs. All of the prescriptions in the present study conformed to WHO guidelines and majority of them with JNC VIII guidelines.Conclusions: The findings of this study are comparable to those of other studies. However, there is a scope of improvement in areas such as overdosing, prescribing more by generic names instead of brand names and from WHO Model List of Essential Medicines.

Role of anti-tissue transglutaminase IgA+IgG antibodies in detection of potential celiac disease in patients with type 1 diabetes

Background & objectives: Celiac disease (CD) can exist in various forms in type 1 diabetes (T1D) patients and can remain undetected, leading to severe complications. This study was aimed to evaluate five commercially available anti-tissue transglutaminase (tTG) ELISA kits with distinct formats for the detection of CD and potential CD in T1D patients. Clinical and demographic profiles of the patients with different disease subsets were also studied. Methods: Fifty T1D patients with classical and non-classical symptoms of CD and 100 T1D patients without any symptoms of CD were included in this study. Anti-tTG autoantibody levels were estimated by five ELISA kits followed by histological examination of duodenal biopsy. HLA DQ2-DQ8 and DRB1-DQB1 typing was done, and serum levels for transforming growth factor (TGF)-?1 were also estimated. Results: Assay format detecting anti-tTG IgA antibodies against recombinant antigens along with neopeptides of gliadin was most efficient in the detection of CD in symptomatic patients, and assay format detecting IgA+IgG helped in the detection of potential CD in asymptomatic T1D patients. These findings were supported by histological examination and human leucocyte antigen analysis. Patients with potential CD were found to have markedly deranged glycaemic control parameters and also had significantly raised serum levels of TGF-?1, (P <0.05) compared to T1D patients. Interpretation & conclusions: Potential CD can be frequently seen in T1D patients. This can be attributed to the dietary patterns prevalent in the subcontinent and the genetic basis of the disease. Anti-tTG IgA+IgG antibodies can be useful in the detection of these potential CD cases in T1D patients. Early intervention with gluten-free diet can be considered in these patients for better disease management.

Anti-inflammatory effect of dikaempferol rhamnopyranoside, a diflavonoid from Eugenia jambolana Lam. Leaves.

Traditionally, the Indian Blackberry or locally called Jamun, Eugenia jambolana Lam. (Syn.: Syzygium cumini), is well known for its pharmacological potential, particularly anti-inflammatory. Here, we studied kaempferol-7-O-α-L-rhamnopyranoside]-4'-O-4'- [kaempferol-7-O-α-L-rhamnopyranoside (EJ-01) isolated from the E. jambolana leaves for possible anti-inflammatory activity. EJ-01 (3, 10 and 30 mg/kg, p.o.) was assessed for anti-inflammatory activity using carrageenan-induced paw edema model in mice by determining edema volume, myeloperoxidase (MPO), nitrite plus nitrate (NOx) and cytokine levels in paw edema tissue. EJ-01 significantly attenuated the edema, MPO levels, tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) levels in the edema of paw at the 5th hour after carrageenan injection at all doses. EJ-01 (30 mg/kg) decreased the nitric oxide (NO) levels of the edema of paw at the 5th hour after carrageenan injection. The anti-inflammatory mechanisms of EJ-01 might be related to the decrease in the level of edema paw by reduced activities of NO and MPO. It probably exerts anti-inflammatory effects through the suppression of TNF-α and IL-1β. Therefore, we conclude that EJ-01 could be positively exploited for itspotential benefits against inflammatory diseases and support the pharmacological basis of E. jambolana as traditional herbal medicine for the treatment of inflammatory diseases.

Plasmacytic or lymphoplasmacytic infiltrate in lymph nodes: Diagnostic approach and differential considerations.

Plasmacytosis is a common finding in lymph node biopsies and can be seen in diverse circumstances ranging from reactive lymphadenopathy to malignant lymphoma. Familiarity with various histopathologic features of the different entities and awareness of their typical clinical and ancillary study findings are essential for an accurate diagnosis. In this review, we present common and representative nonneoplastic entities and lymphomas that have plasmacytic differentiation or associated plasmacytosis. We focus on the histological classification with an emphasis on the diagnostic approach and areas of diagnostic challenge.

Vitamin-D-deficiency rickets even with abundant sunlight -A case to highlight emerging problem

We describe a case of vitamin-D-deficiency rickets in a young child to highlight its existence in Malaysia where sunlight is abundant throughout the year. The child presented with deformity of both legs. He came from an educated urban family but remained indoors most of the time. Radiographs of knees and wrists showed changes of florid rickets. Low serum 25-hydoxyvitamin-D, high parathyroid hormone, normal serum phosphate and calcium levels, and normal renal function clinched the diagnosis of vitamin-D-deficiency rickets. He improved remarkably after treatment with oral Vitamin-D. We emphasise the importance of exposure to sunlight to prevent rickets.

How better is random blinded re‑checking results in Revised National TB Control Programme, India.

Background: The Revised National Tuberculosis Control Programme (RNTCP) is implementing the External Quality assurance (EQA) and Random blinded re-checking (RBRC) as one of its important component. This nationwide study was conducted to determine (1) the number and types of RBRC errors and (2) the sensitivity and specificity among rechecked slides. Materials and Methods: The study was based on the monthly RBRC reports submitted by ~13,000 designated microscopy centres (DMCs) across the country under routine programmatic settings in 2010. The DMCs reports were compiled at district, state and national level. Results: A total of 11, 89,564 slides were rechecked from 11,039 DMCs. Of which 99.5% of rechecked slides did not have any errors. The sensitivity and specificity of the rechecked slides had 98% sensitivity and 100% specificity. Conclusion: RBRC is the crucial component of EQA and the results from the programme are found to be satisfactory. Based on the study findings, the earlier value of 80% sensitivity used for calculation of annual sample size for RBRC has been increased to 90% sensitivity. The annual RBRC sample size for DMCs has been increased by 1.5–2 folds.

Neonatal Bartter Syndrome.

Bartter syndrome is characterized by hypokalemia, metabolic alkalosis, increased urinary excretion of sodium, potassium and chloride and normal blood pressure. A rare subset of the disorder occurs in the newborn period, which prompts us to report two such cases. Both showed satisfactory response to treatment with indomethacin.

Analysis of the Neoplastic Nature of Odontogenic Keratocyst and its Comparison with other Selected Benign Odontogenic Tumours: An Immunohistochemical Analysis

Odontogenic keratocyst (OKC) first described by Philipsen in 1956 constitutes approximately 11% of all cysts of the jaws. Adenomatoid odontogenic tumour (AOT) is an uncommon, benign epithelial lesion of odontogenic origin. The aim of this study was to analyse the expression of Bcl-2 in OKC and its comparison with other selected benign odontogenic tumours (OTs). Ten formalin fixed paraffin embedded blocks of OKCs, five each of AOT and unicystic ameloblastoma Bcl-2 protein is characterized by its ability to inhibit apoptosis. OKC were characterized by higher expression of Bcl-2 in basal cell epithelium. AOT and unicystic ameloblastoma differed from OKC in a wide spectrum of apoptosis and/or cell cycle-related protein expressions, higher proliferation in the basal cell layer, and vice versa, lower proliferation in the suprabasal cell layer. The solitary OKC seems to be less biologically aggressive and should be classified as a cyst rather than a tumour, means that at least few of OKCs manifests as ordinary cysts. Some of the present study findings could support the theory that OKCs are with high proliferative, probably that these lesions are developmental cysts with some neoplastic properties because of the high intrinsic growth potential. WHO recommends the term KCOT as it better reflects the neoplastic nature of the lesion; however, this reclassification has not yet been universally accepted.

Colloid cyst of the third ventricle presenting with features of terson's syndrome

This report describes a middle-aged man presenting to the ophthalmologist with history of seeing floaters before both eyes since 2-weeks duration. A history of intermittent headache and dizziness of recent onset was elicited on questioning. Ocular examination showed bilateral early papilloedema and mild vitreous hemorrhage. Brain computed tomography [CT] disclosed features suggestive of colloid cyst of the third ventricle in the region of foramen of Monro with moderate hydrocephalus. Emergency craniotomy and excision of the cyst was done, and the patient is doing well for the last 18 months after the surgical intervention. The mechanism of this presentation, importance of early investigations, and timely intervention are highlighted in order to avoid serious neurological sequelae. The literature was extensively reviewed for atypical presentations of intraventricular colloid cyst

Immunohistochemical analysis of CK 18 in dental follicles of impacted third molars: A pilot study.

Objective: Odontogenic tumors are lesions derived from epithelial, ectomesenchymal, and/or mesenchymal elements that still are, or have been, part of the tooth-forming apparatus. Approximately 80% of odontogenic tumors occur in the mandible, with a marked predilection for the posterior region, and are often associated with an unerupted tooth. The aim of this study was to determine whether cytokeratin (CK) 18 immunostaining decorated the follicular tissue removed at the time of prophylactic extraction of impacted mandibular third molars, which might suggest oncofetal transformation. Materials and Methods : Fifty-four impactions met the study inclusion criteria, of which 24 cases showed the presence of reduced enamel epithelium and/or connective tissue with odontogenic epithelium, which were subjected to CK 18 immunostaining. Results: All 24 cases with adequate epithelium were CK 18 immunonegative. Conclusion: There was no oncofetal transformation in the odontogenic epithelia of the dental follicles studied. Thus, although we reaffirm that evaluation of follicular tissue is imperative since disease conditions may be found in minute follicular spaces, development of odontogenic cysts and tumors is unlikely.

Lymphomas of the gastro-intestinal tract - Pathophysiology, pathology, and differential diagnosis.

The gastrointestinal tract (GIT) is the most commonly involved site of extranodal lymphomas. The close association between chronic inflammation and specific GIT lymphomas not only provide interesting insights into the pathobiology of lymphomas but also poses unique diagnostic challenges. A clear understanding of marginal zone and mucosa associated lymphoid tissue (MALT) in health and disease is helpful to place GIT lymphomas in proper context. A wide variety of lymphomas besides MALT lymphomas occur in various parts of the GIT. The characteristic pathological, immunophenotypic, and genetic features of different GIT lymphomas categorized according to World Health Organization (WHO) classification are presented. The epidemiological, clinical, and pathological features of lymphomas occurring in each part of the GIT are summarized and the key points regarding lymphomas at each site are emphasized. A tabular summary of the important differential diagnostic considerations at each site is given and suggestions for a minimal diagnostic work up are provided.

Effect of Zinc Salts on Acid Secretion and Peptic Ulceration in Albino Rats.

The present study was carried out to see the effect of two zinc salts i.e zinc sulphate and zinc chloride on gastric ulcers induced by stress, pylorus ligation and aspirin in albino rats. The rats were divided into two main groups (zinc sulphate 30, 60, 90 mg/kg i.p and zinc chloride 10 and 20mg/kg i.p). They were further sub-divided into three sub-groups dependant on ulcer model i.e stress, pylorus ligation and aspirin induced ulcers. It was found that zinc sulphate and zinc chloride had a dose dependant reduction in ulcer index in all three models of gastric ulceration. Also, both the salts had anti acid secretory effect, raised pH of gastric secretion and reduced total acidity significantly. Thus zinc salts prevent gastric ulceration. Probably this effect is mediated by anti acid secretory action.

Antibacterial studies on leaves of clitoria ternatea linn. - a high potential medicinal plant.

The aim of the present study was to investigate the antibacterial properties of Clitoria ternatea. The organic solvent (Petroleum ether, Ethyl acetate and Methanol) extracts from the leaves of Clitoria ternatea (Papilionoideae) were tested against Bacillus cereus, Staphylococcus aureus, Klebsiella pneumonia, Proteus vulgaris and Salmonella typhi by agar disc and well diffusion methods. The results showed promising antibacterial activity against the tested microbial pathogens. Among these, methanol extract was found to possess a more potent inhibitory activity effect when compared to the other extracts (Petroleum ether and Ethyl acetate). The results of this study validate the use methanol extract of this species in ethnomedicine, favouring the isolation of antibacterial agents from the leaf extracts of Clitoria ternatea.

Fluoride content in bottled drinking waters, carbonated soft drinks and fruit juices in Davangere city, India.

Background: The regular ingestion of fluoride lowers the prevalence of dental caries. The total daily intake of fluoride for optimal dental health should be 0.05-0.07 mg fluoride/kg body weight and to avoid the risk of dental fluorosis, the daily intake should not exceed a daily level of 0.10 mg fluoride/kg body weight. The main source of fluoride is from drinking water and other beverages. As in other countries, consumption of bottled water, juices and carbonated beverages has increased in our country. Objective: To analyze the fluoride content in bottled water, juices and carbonated soft drinks that were commonly available in Davangere city. Materials and Methods: Three samples of 10 commercially available brands of bottled drinking water, 12 fruit juices and 12 carbonated soft drinks were purchased. Bottled water and carbonated soft drinks were stored at a cold place until fluoride analysis was performed and a clear juice was prepared using different fruits without the addition of water. Then, the fluoride analysis was performed. Results: The mean and standard deviation of fluoride content of bottled water, fruit juices and carbonated soft drinks were measured, which were found to be 0.20 mg (±0.19) F/L, 0.29 mg (±0.06) F/L and 0.22 mg (±0.05) F/L, respectively. Conclusion: In viewing the results of the present study, it can be concluded that regulation of the optimal range of fluoride in bottled drinking water, carbonated soft drinks and fruit juices should be drawn for the Indian scenario.

The effect of smoking on gingival crevicular fluid levels of myeloperoxidase.

Objectives : To compare the gingival crevicular fluid (GCF) myeloperoxidase (GM) levels in smokers and non-smokers. Materials and methods : This study comprised 45 subjects: (a) 12 smokers with periodontitis, (b) 10 non-smokers with periodontitis, (c) 11 smokers with healthy periodontium, and (d) 12 non-smokers with healthy periodontium were recruited for the study and their GM levels were analyzed. Results and conclusion : GM levels were significantly higher in smokers with periodontitis compared with others. Hence, more incidence of mutagenesis and cytotoxicity were noted at sites of inflammation mediated by GM in smokers compared with non-smokers.