Six-minute walk test for assessment of work capability in patients with chronic obstructive pulmonary disease: A cross-sectional comparative study

Background: Chronic obstructive pulmonary disease (COPD) is a systemic disorder causing morbidity, disability, and mortality throughout the world. Although, spirometry parameters have been used for decades to diagnose COPD as well as to grade the severity of this disease, others factors such as the BMI, degree of inflation, and exercise capacity have become important outcome measures for extra-pulmonary manifestations. The 6-min walk test (6MWT) is considered as a simple test to assess the functional capacity of COPD patients. The aim of our study was to implement 6MWT in patients of COPD in our setup to predict morbidity. Aims and Objectives: The objective of our study was to implement 6MWT in patients of COPD in our setup to predict morbidity. Materials and Methods: A cross-sectional comparative study was conducted on thirty COPD patients and thirty control subjects. All the subjects were investigated through history taking, clinical examination, spirometry, and 6MWT in the Department of Physiology, R.G. Kar Medical College and Hospital, Kolkata. Statistical analysis was done by SPSS version-21. Results: The values of the spirometry parameters were significantly reduced in cases than in the controls (P < 0.05). The values of 6-min walk distance as well as 6-min work (6MWORK) were also significantly reduced in cases than in the controls (P = 0.0023 and P = 0.0028, respectively). A strong positive correlation was found between forced vital capacity and 6MWORK (r = 0.556), BMI, and 6MWORK (r = 0.84) in patients of COPD. Conclusion: Our study substantiates that 6MWT can be implemented in our set up to assess the work capability and thus to predict morbidity in patients of COPD.

Study of heart rate variability to assess autonomic dysfunction in patients with chronic obstructive pulmonary disease of a tertiary care hospital of West Bengal: A cross-sectional comparative study

Background: Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality throughout the world. COPD and its complications also lead to a large number of deaths every year in our country. Cardiac arrhythmias and sudden cardiac death are the major complications of COPD leading to death and disability. Such cardiac complications are often a result of autonomic dysfunction. Aims and Objectives: This study aims to find out the autonomic dysfunction in moderate COPD patients by comparing their heart rate variability (HRV) parameters with age and sex matched healthy controls. Materials and Methods: After obtaining approval from the Institutional Ethics Committee, 48 patients of moderate COPD and 54 healthy subjects were assessed and compared with respect to their HRV parameters which included Mean RR, Mean HR, SDNN, NN50, pNN50, root mean square of successive differences (RMSSD), high frequency (HF), low frequency (LF), LF/HF ratio, and SD2/SD1 ratio. Results: It was found that in comparison to healthy controls, patients of moderate COPD had significant alteration in the following HRV parameters – Mean HR (P: 0.001), RMSSD (P: 0.002), SDNN (P: 0.015), NN50 (P: 0.001), pNN50 (P: 0.000), HF (NU/normalized unit) [P: 0.033], HF (%) [P: 0.002], LF (NU/normalized unit) [P: 0.033], LF (%) [P: 0.012], and LF/HF (P: 0.033). Conclusion: As there is a significant alteration of several HRV parameters in moderate COPD patients, we conclude that HRV measurement may subserve as a simple and non-invasive tool to assess autonomic dysfunction in patients of COPD at the earliest.

Rapid detection of drug-resistant Mycobacterium tuberculosis directly from clinical specimens using allele-specific polymerase chain reaction assay

Background & objectives: Rapid detection of drug resistance in Mycobacterium tuberculosis (MTB) is essential for the efficient control of tuberculosis. Hence, in this study a nested-allele-specific (NAS) PCR, nested multiple allele-specific PCR (NMAS-PCR) and multiple allele-specific (MAS) PCR assays were evaluated that enabled detection of the most common mutations responsible for isoniazid (INH) and rifampicin (RIF) resistance in MTB isolates directly from clinical specimens. Methods: Six pairs of primers, mutated and wild type, were used for the six targets such as codon 516, 526 and 531 of rpoB, codon 315 of katG and C15-T substitution in the promoter region of mabA-inhA using allele-specific (AS) PCR assays (NAS-PCR, NMAS-PCR and MAS-PCR). The performance of AS PCR method was compared with phenotypic drug susceptibility testing (DST). Results: The usefulness of AS PCR assays was evaluated with 391 clinical specimens (251 Acid fast bacilli smear positive and MTB culture positive; 93 smear negative and MTB culture positive; 47 smear positive and MTB culture negative) and 344 MTB culture positive isolates. With culture-based phenotypic DST as a reference standard, the sensitivity and specificity of the NAS-PCR, NMAS-PCR and MAS-PCR assay for drug resistance-related genetic mutation detection were 98.6 and 97.8 per cent for INH, 97.5 and 97.9 per cent for RIF and 98.9 and 100 per cent for multidrug resistance (MDR). Interpretation & conclusions: The performance of AS PCR assays showed that those could be less expensive and technically executable methods for rapid detection of MDR-TB directly from clinical specimens.

A case report of Blastocystis infection and Steven Johnson’s syndrome

@#Blastocystis species (spp.) is an emerging pathogen. There are several unsolved issues linked to this parasite ranging from its nomenclature, commensal status, standardization of laboratory diagnostic methods, genotypes and treatment. Recently, there has been an increase in reports of Blastocystis spp. from symptomatic cases which provide enough evidence of its pathogenic potential. A range of signs and symptoms, from gastro-intestinal to cutaneous manifestations have been attributed to Blastocystis infection. Few reports have established an association between intestinal infection with Blastocystis spp. and skin manifestations in form of urticaria, palmoplantar pruritus and allergy with complete resolution of cutaneous lesions with eradication of the parasite. In this report, we describe a case of Steven Johnson’s syndrome (SJS) in a 6 years old girl along with infection with Blastocystis spp. marked by diarrhea and abdominal pain. Stool examination revealed the presence of all forms of the parasite with subsequent decrease in parasite burden and diarrhea over a period of time. Interestingly, the clearance of Blastocystis spp. from stool was followed by recovery from skin lesions and other symptoms. In this case, the course of SJS was clearly associated with Blastocystis infection. Though skin manifestation with Blastocystis infection has been previously reported, this is the first report of its association with SJS. This report indicates newer insights of the parasite that are less well studied.

Identification, antifungal resistance profile, in vitro biofilm formation and ultrastructural characteristics of Candida species isolated from diabetic foot patients in Northern India.

Purpose: Diabetic foot ulcers are a serious cause of diagnostic and therapeutic concern. The following study was undertaken to determine the fungal causes of diabetic foot ulcers, with their phenotypic and genotypic characterisation. Materials and Methods: A total of 155 diabetic foot ulcers were studied for 1 year. Deep tissue specimen was collected from the wounds, and crushed samples were plated on Sabouraud dextrose agar with chloramphenicol (0.05 g). Identification was done by growth on cornmeal agar, germ tube formation and urease test. For molecular identification, conserved portion of the 18S rDNA region, the adjacent internal transcribed spacer 1 (ITS1) and a portion of the 28S rDNA region were amplified, using the ITS1 and ITS2 primers. Antifungal susceptibility against voriconazole, fluconazole and amphotericin B was determined by standard broth microdilution method. Biofilm formation was studied in three steps. First, on the surface of wells of microtiter plates followed by quantification of growth by fungal metabolism measurement. Finally, biofilms were analysed by scanning electron microscopy (SEM). Results: Fungal aetiology was found in 75 patients (48.38%). All were identified as Candida species (100%). The prevalence of different species was Candida tropicalis (34.6%), Candida albicans (29.3%), Candida krusei (16.0%), Candida parapsilosis (10.6%), Candida glabrata (9.33%). All were susceptible to amphotericin B (100%). On microtiter plate, all the isolates were viable within 48 h showing biofilms. The metabolic activity of cells in the biofilm increased with cellular mass, especially in the first 24 h. On SEM, majority showed budding yeast form. Conclusion: Non‑albicans Candida spp. with potential biofilm forming ability are emerging as a predominant cause of diabetic foot ulcers.

Co-existence of Pseudomonas-derived cephalosporinase among plasmid encoded CMY-2 harbouring isolates of Pseudomonas aeruginosa in north India.

Context: In Pseudomonas aeruginosa, AmpC β-lactamases are often responsible for high-level resistance to β-lactam antibiotics. The co-production of plasmid-mediated AmpC along with chromosomal Pseudomonas-derived cephalosporinases thus remain a serious clinical concern owing to high resistance spectrum towards antibiotics. Aim: The present study was performed to investigate the co-existence of both chromosomally-encoded and plasmid-mediated AmpC β-lactamase among clinical isolates of P. aeruginosa. Setting and Design: It is a cross-sectional study carried out in the Department of Microbiology in a tertiary referral hospital of northern India. Methods and Methods: A total of 329 consecutive, non-duplicate clinical isolates of P. aeruginosa, were selected for the detection of AmpC β-lactamases and confirmed for AmpC production by modified three dimensional (M3D) test. Ceftazidime -imipenem antagonism test was used to detect inducible AmpC producers. Molecular characterisation of chromosomally-encoded blaPDC and plasmid-mediated AmpC gene was studied by performing polymerase chain reaction (PCR). Result: A total of 214 (65%) isolates were confirmed for AmpC production by M3D test. On performing multiplex PCR, 27 isolates were detected posessing blaCMY type of plasmid-mediated AmpC gene. While 48 isolates were found to harbour chromosomally-encoded blaPDC gene co-production of both chromosomal and plasmid-encoded AmpC was reported in eleven isolates. Conclusions: Although these chromosomally-encoded cephalosporinases might spread more slowly than mobilised AmpC, but it is likely that in the present scenario of intense antibiotic pressure, this will become an increasing problem and may further limit our antibiotic choices.

Study of sodium arsenite induced biochemical changes on certain biomolecules of the freshwater catfish Clarias batrachus

Toxic impact of sublethal concentration (1 mg/L; 5% of 96h LC50 value) of sodium arsenite (NaAsO2) on certain biomolecules (proteins, nucleic acids, lipids, and glycogen) of five tissue components (muscles, liver, brain, skin, and gills) of the freshwater catfish Clarias batrachus was analysed. The important toxic manifestations include marked decrease in the concentration of proteins (21.72-45.42% in muscles; 3.42-53.94% in liver; 15.39-45.42% in brain; 15.40-4.00% in skin and 11.35-64.13% in gills), DNA (0.55-22.95% in muscles; 8.33-14.06% in liver; 5.30-18.40% in brain; 13.57-52.80% in skin; and 12.38-31.01% in gills), RNA (42.68-76.16% in muscles; 10.68-39.75% in liver; 5.66-29.05% in brain; 7.72-27.93% in skin and 21.47-44.38% in gills) and glycogen (24.00-51.72% in muscles; 49.11-72.45% in liver; 11.49-26.03% in brain; 26.13-38.05% in skin and 17.80-37.97% in gills). Excepting liver where the lipid content increases (15.82-24.13%), the fat content also showed depletion in their concentration (10.40-29.83% in muscles; 8.30-34.45% in brain; 8.94-31.47% in skin and 12.75-28.86% in gills), in the rest of the organ systems.

Foi analisado o impacto tóxico da concentração subletal (1 mg/L; 5% do valor de LC50 de 96h) do arsenito de sódio (NaAsO2) sobre certas biomoléculas (proteinas, ácidos nucleicos, lipídios e glicogênio) de cinco tecidos (músculos, fígado, cérebro, pele e brânquias) do bagre Clarias batrachus. As manifestações tóxicas importantes incluiram o decréscimo acentuado na concentração de proteinas (21,72-45,42% nos músculos; 3,42-53,94% no fígado; 15,39-45,42% no cérebro; 15,40-4,00% na pele e 11,35-64,13% nas brânquias), DNA (0,55-22,95% nos músculos; 8,33-14,06% no fígado; 5,30-18,40% no cérebro; 13,57-52,80% na pele e 12,38-31,01% nas brânquias), RNA (42,68-76,16% nos músculos; 10,68-39,75% no fígado; 5,66-29,05% no cérebro; 7,72-27,93% na pele e 21,47-44,38% nas brânquias) e glicogênio (24,00-51,72% nos músculos; 49,11-72,45% no fígado; 11,49-26,03% no cérebro; 26,13-38,05% na pele e 17,80-37,97% nas brânquias). Excetuando o fígado onde o conteúdo de lipídeos aumentou (15,82-24,13%), houve uma depleção na concentração de lipídeos no restante dos sistemas orgânicos (10,40-29,83% nos músculos; 8,30-34,45% no cérebro; 8,94-31,47% na pele e 12,75-28,86% nas brânquias).

Study of sodium arsenite induced biochemical changes on certain biomolecules of the freshwater catfish Clarias batrachus

Toxic impact of sublethal concentration (1 mg/L; 5% of 96h LC50 value) of sodium arsenite (NaAsO2) on certain biomolecules (proteins, nucleic acids, lipids, and glycogen) of five tissue components (muscles, liver, brain, skin, and gills) of the freshwater catfish Clarias batrachus was analysed. The important toxic manifestations include marked decrease in the concentration of proteins (21.72-45.42% in muscles; 3.42-53.94% in liver; 15.39-45.42% in brain; 15.40-4.00% in skin and 11.35-64.13% in gills), DNA (0.55-22.95% in muscles; 8.33-14.06% in liver; 5.30-18.40% in brain; 13.57-52.80% in skin; and 12.38-31.01% in gills), RNA (42.68-76.16% in muscles; 10.68-39.75% in liver; 5.66-29.05% in brain; 7.72-27.93% in skin and 21.47-44.38% in gills) and glycogen (24.00-51.72% in muscles; 49.11-72.45% in liver; 11.49-26.03% in brain; 26.13-38.05% in skin and 17.80-37.97% in gills). Excepting liver where the lipid content increases (15.82-24.13%), the fat content also showed depletion in their concentration (10.40-29.83% in muscles; 8.30-34.45% in brain; 8.94-31.47% in skin and 12.75-28.86% in gills), in the rest of the organ systems.

Foi analisado o impacto tóxico da concentração subletal (1 mg/L; 5% do valor de LC50 de 96h) do arsenito de sódio (NaAsO2) sobre certas biomoléculas (proteinas, ácidos nucleicos, lipídios e glicogênio) de cinco tecidos (músculos, fígado, cérebro, pele e brânquias) do bagre Clarias batrachus. As manifestações tóxicas importantes incluiram o decréscimo acentuado na concentração de proteinas (21,72-45,42% nos músculos; 3,42-53,94% no fígado; 15,39-45,42% no cérebro; 15,40-4,00% na pele e 11,35-64,13% nas brânquias), DNA (0,55-22,95% nos músculos; 8,33-14,06% no fígado; 5,30-18,40% no cérebro; 13,57-52,80% na pele e 12,38-31,01% nas brânquias), RNA (42,68-76,16% nos músculos; 10,68-39,75% no fígado; 5,66-29,05% no cérebro; 7,72-27,93% na pele e 21,47-44,38% nas brânquias) e glicogênio (24,00-51,72% nos músculos; 49,11-72,45% no fígado; 11,49-26,03% no cérebro; 26,13-38,05% na pele e 17,80-37,97% nas brânquias). Excetuando o fígado onde o conteúdo de lipídeos aumentou (15,82-24,13%), houve uma depleção na concentração de lipídeos no restante dos sistemas orgânicos (10,40-29,83% nos músculos; 8,30-34,45% no cérebro; 8,94-31,47% na pele e 12,75-28,86% nas brânquias).

Prevalence of major neurological disorders among geriatric population in the metropolitan city of Kolkata.

Well-conducted neuroepidemiological studies for the geriatric population are rare in India. In view of the growing aging population, we planned to determine the prevalence of common neurological disorders among the elderly population in the city of Kolkata. This was a cross-sectional study of a stratified random sample of the city population and carried in two stages through house to house survey. Initially, trained non-medical workers screened the cases with a validated family questionnaire and then a neurologist examined all the screened positive cases. A validated neuropsychological screening test was also applied among the elderly population with cognitive complaints. Results showed prevalence rates (per 1000 elderly population--> or = 60 years) of following disorders in decreasing order: stroke--33.93, essential tremor--13.76, dementia--7.89, Parkinsonism--3.30 and epilepsy--2.57. Sex-specific prevalence showed that stroke was commoner among men and that of other disorders among women. Age-specific prevalence recorded progressive increase in the rates of all disorders among both genders, though not uniformly among women. Overall the crude prevalence of neurological disorders was 60.9 per 1000. The present study shows higher rate of stroke as compared to other neurological disorders among elderly population in India, which needs urgent attention.

A random sample survey for prevalence of major neurological disorders in Kolkata.

BACKGROUND & OBJECTIVES: Large scale epidemiological studies on neurological disorders are very few in India. We therefore planned to conduct a cross-sectional population-based epidemiological study on a stratified randomly selected sample from the city of Kolkata to study the prevalence of major neurological disorders such as epilepsy, stroke, dementia and Parkinsonism. METHODS: The method of case ascertainment was two- stage house-to-house survey; the first stage was undertaken by a field team consisting of four field workers and a neuropsychologist. Screening questionnaire based on National Institute of Mental Health and Neuro Sciences (NIMHANS) protocol was used. In the second stage a neurologist examined all the screened positive cases. RESULTS: A total of 52,377 subjects participated in the study. The crude prevalence rates (per 100,000 population) of major neurological disorders with 95 per cent confidence intervals (95% CI) and age adjusted rates (AAR) based on US 2000 population were 557.5 (95% CI 496.17-624.40 and AAR - 516.77) in epilepsy, 486.85 (95% CI 377.0 to 551.11 and AAR-765.68) in stroke, 87.82 (95% CI 64.02-117.50 and AAR-168.4) in dementia and 45.82 (95% CI 29.64-67.63 and AAR-71.64) in Parkinsonism. The weighted prevalence rates (per 100,000) of the whole population based on re-screening of 10 per cent of negative samples were 763.89 (95% CI 690.55- 842.57) in epilepsy, 624.32 (95% CI 555.64-699.24) in stroke and 139.37 (95% CI 108.71-176.06) in dementia. INTERPRETATION & CONCLUSION: A high rate of stroke and overall lower prevalence of Parkinsonism and dementia was recorded as compared to western studies. High prevalence rate of stroke emphasizes the need to study incidence, morbidity and mortality profile of stroke including its socio-economic impact and also case-control analysis to determine the underlying risk factors.

Aicardi syndrome: a report of five Indian cases.

Five Indian cases of Aicardi syndrome, aged 1-13 years and all with the classic triad of infantile spasm, corpus callosal agenesis and chorioretinal lacunae, were presented. The purpose of this report was to demonstrate the clinical, electroencephalographic (EEG) and radiological spectrum and the treatment outcome of this disorder among the Indians. None of the patient had any family history of similar illness. All had profound psychomotor impairment with no meaningful speech development. There were microphthalmia in 2, optic disc coloboma in 1, interhemispheric cyst in 1, periventricular heterotopia in 2 and thoracolumbar kyphoscoliosis in 2 cases. They all had early onset epilepsy and there were multiple types of seizures. Two cases (40%) had the characteristic dissociated burst-suppression pattern in EEG. Two cases whose antiepileptic medications included vigabatrin had complete control of seizure.

Gallotannin hydrolysis by immobilized fungal mycelia in a packed bed bioreactor.

Hydrolysis of gallotannin to gallic acid by immobilized mycelia of Aspergillus niger MTCC 282, Aspergillus fischerii MTCC 150, Fusarium solani MTCC 350 and Trichoderma viride MTCC 167 in a packed bed bioreactor was studied. Fungal mycelia preinduced with 5 g L-1 gallotannin were immobilized in calcium alginate gel (1.5%) and the resultant beads were packed in a column to a bed volume of 175 mm3. Gallotannin dissolved in distilled water was passed through the column and the eluate was recycled after adjusting pH to 6 with ammonium hydroxide (10%). Maximum hydrolysis of gallotannin was recorded by immobilized mycelia of F. solani and T. viride at 35 degrees and 45 degrees C after 175 and 60 min of residency period respectively. Optimum substrate concentration required for maximum hydrolysis was 10 g L-1 at pH 5 for both the fungi. Immobilized mycelia of A. niger and A. fischerii revealed maximum operational stability. Loss of activity after eighth run was in the order of-A. niger (no loss), A. fischerii (7.5%), F. solani (18%) and T. viride (18%). Stability in terms of retention of enzyme activity after 150 days of storage at 4 degrees C was A. niger (58%), A. fischerii (26.8%), F. solani (83%) and T. viride (85.1%).

Ammonium sulphate induced stress related alterations in the respiratory epithelium of the airbreathing organ of the catfish Heteropneustes fossilis (Bloch).

In this paper, histopathological changes in the inner lining of the accessory respiratory organ of Heteropneustes fossilis following exposure to sublethal concentration (0·2 g I -1) of ammonium sulphate (3 mg I-1 total ammonia-N) has been described. The goblet cells show periodic increased followed by decreased secretory activities. Necrosis and shedding of the epithelial cells over the secondary lamellae cause periodic haemorrhages which lead to degeneration and decreased number of secondary lamellae. Subsequently regeneration takes place each time as evidenced by the appearance of inflammatory tissue. Fusion of more than one secondary lamellae is also common. Regeneration also leads to uncontrolled hyperplasia of haphazardly arranged epithelial cells. This hyperplasia causes increased distance of respiratory blood-air barrier in the secondary lamellae, leading to impaired normal aerial respiration.