Rickettsial Infections among the Undifferentiated Febrile Patients Attending a Tertiary Care Teaching Hospital of Northern India: A Longitudinal Study

Background@#Acute undifferentiated febrile illness (AUFI) is one of the most daunting challenges a physician faces in such settings. Among AUFI, rickettsial infections are most common and related infections (such as anaplasmosis, ehrlichiosis, and Q fever) which are caused by an unusual type of bacteria that can live only inside the cells of another organism. The present study was therefore planned with an objective to estimate the prevalence of rickettsial infection among patients of undifferentiated fever and to determine any association of socio-demographic characteristics with rickettsial disease. @*Materials and Methods@#Patients presenting with febrile illness and admitted or attending out-patient department of Sher-i-Kashmir Institute of Medical Sciences, Srinagar was approached and recruited in the study. Weil Felix Assay, enzyme-linked immunosorbent assay and indirect immunofluorescence assay were done to detect the anti-rickettsial antibodies. Serological evidence of a fourfold increase in IgG-specific antibody titer reactive with spotted fever group rickettsial antigen by indirect immunofluorescence antibody assays between paired serum specimens was considered a confirmatory diagnosis for the rickettsial disease. @*Results@#Most of the patients were males 61.6%, and most 46.2% were in the age group of 20 -39 years. Most of the patients, 80.8% belonged to rural areas, and 48% belonged to the upper middle (II) class of the socio-economic class according to modified Kuppuswamy scale. Of the studied participants, a majority, 47.0%, were determined undiagnosed, while 15.4% studied participants were diagnosed to have a rickettsial disease. In patients positive for typhus group, 67.8% were IgM positive, 28.5% were IgG positive, and only 3% were positive for IgM and IgG. In patients positive for Scrub Typhus Group, 32.7% were positive for IgM, and 62.0% were positive for IgG, and only 5.0% were positive for both IgM and IgG. In patients positive for spotted fever group, 36.1% were positive for IgM, and 58.5% were positive for IgG, and only 5.5% were positive for both IgM and IgG. The prevalence of rickettsial disease was found to be 11.3%. @*Conclusion@#Rickettsial diseases, typhoid and brucellosis, were the most prevalent diseased diagnosed among patients reporting to hospitals with undifferentiated febrile illness.Clinicians must consider rickettsial diseases as one of the differential diagnosis while treating patients with fever.

Rickettsial Infections among the Undifferentiated Febrile Patients Attending a Tertiary Care Teaching Hospital of Northern India: A Longitudinal Study

Background@#Acute undifferentiated febrile illness (AUFI) is one of the most daunting challenges a physician faces in such settings. Among AUFI, rickettsial infections are most common and related infections (such as anaplasmosis, ehrlichiosis, and Q fever) which are caused by an unusual type of bacteria that can live only inside the cells of another organism. The present study was therefore planned with an objective to estimate the prevalence of rickettsial infection among patients of undifferentiated fever and to determine any association of socio-demographic characteristics with rickettsial disease. @*Materials and Methods@#Patients presenting with febrile illness and admitted or attending out-patient department of Sher-i-Kashmir Institute of Medical Sciences, Srinagar was approached and recruited in the study. Weil Felix Assay, enzyme-linked immunosorbent assay and indirect immunofluorescence assay were done to detect the anti-rickettsial antibodies. Serological evidence of a fourfold increase in IgG-specific antibody titer reactive with spotted fever group rickettsial antigen by indirect immunofluorescence antibody assays between paired serum specimens was considered a confirmatory diagnosis for the rickettsial disease. @*Results@#Most of the patients were males 61.6%, and most 46.2% were in the age group of 20 -39 years. Most of the patients, 80.8% belonged to rural areas, and 48% belonged to the upper middle (II) class of the socio-economic class according to modified Kuppuswamy scale. Of the studied participants, a majority, 47.0%, were determined undiagnosed, while 15.4% studied participants were diagnosed to have a rickettsial disease. In patients positive for typhus group, 67.8% were IgM positive, 28.5% were IgG positive, and only 3% were positive for IgM and IgG. In patients positive for Scrub Typhus Group, 32.7% were positive for IgM, and 62.0% were positive for IgG, and only 5.0% were positive for both IgM and IgG. In patients positive for spotted fever group, 36.1% were positive for IgM, and 58.5% were positive for IgG, and only 5.5% were positive for both IgM and IgG. The prevalence of rickettsial disease was found to be 11.3%. @*Conclusion@#Rickettsial diseases, typhoid and brucellosis, were the most prevalent diseased diagnosed among patients reporting to hospitals with undifferentiated febrile illness.Clinicians must consider rickettsial diseases as one of the differential diagnosis while treating patients with fever.

Chemical characterization, docking studies, anti-arthritic activity and acute oral toxicity of Convolvulus arvensis L. leaves

Objective: To evaluate acute oral toxicity and anti-arthritic activity of the methanolic extract of Convolvulus arvensis L. leaves. Methods: Safety was assessed by acute oral toxicity (OECD 425) study. Anti-arthritic activity was explored by in vitro (inhibition of protein denaturation) and in vivo (Complete Freund's adjuvant-induced arthritis and carrageenan-induced inflammation) methods. Antioxidant potential was determined by assessing ferric reducing power, DPPH inhibition, and H

Computed tomography based pancreatic volume measurement in kashmiri population

Background: The volume of various abdominal organs varies with age, height, weight and body mass index (BMI).Scanning of the viscera is carried out to know the normal dimensions and volumes. Studies have shown that thevolume of pancreas is influenced by age, gender, ethnicity, weight, height and BMI. Organ volume and functionreflect the health of the organs. Altered volume of pancreas is associated with infective, infiltrative, immunological,infestative and malignant conditions. Anthropometry varies with races and regions of the world. Specific ethnicpopulation nomograms are needed for proper medical diagnosis and for monitoring disease progress.Results: A total of 300 eligible subjects between 20-60 years of age, who were to undergo abdominal computedtomography (CT) due to various indications, were included in the study. In our study the mean pancreatic volume(PV) was 115.71+-33.60 cm3. Pancreatic volume was significantly correlated with weight, height and BMI of thesubjects in our study.Conclusion: Nomograms from this data can be used locally for Kashmiri ethnic population to allow clinicians toestimate more accurately the degree of atrophy or hypertrophy of organs in certain disorders and thus, avoidfalse positive and false negative diagnosis of pathological enlargement or reduction of pancreas in clinicalpractice.

Comparison between peak systolic velocity of the inferior thyroid artery and technetium-99m pertechnetate thyroid uptake in differentiating Graves' disease from thyroiditis

ABSTRACT Objectives The differentiation between the various etiologies of thyrotoxicosis, including those with hyperthyroidism (especially Graves' disease [GD], the most common cause of hyperthyroidism) and without hyperthyroidism (like thyroiditis), is an important step in planning specific therapy. Technetium-99m (99mTc) pertechnetate thyroid scanning is the gold standard in differentiating GD from thyroiditis. However, this technique has limited availability, is contraindicated in pregnancy and lactation, and is not helpful in cases with history of recent exposure to excess iodine. The aim of this study was to identify the diagnostic value of the peak systolic velocity of the inferior thyroid artery (PSV-ITA) assessed by color-flow Doppler ultrasound (CFDU) and compare the sensitivity and specificity of this method versus 99mTc pertechnetate thyroid uptake. Subjects and methods We prospectively analyzed 65 patients (46 with GD and 19 with thyroiditis). All patients were evaluated with clinical history and physical examination and underwent 99mTc pertechnetate scanning and measurement of TRAb levels and PSV-ITA values by CFDU. The diagnosis was based on findings from signs and symptoms, physical examination, and 99mTc pertechnetate uptake. Results Patients with GD had significantly higher mean PSV-ITA values than those with thyroiditis. At a mean PSV-ITA cutoff value of 30 cm/sec, PSV-ITA discriminated GD from thyroiditis with a sensitivity of 91% and specificity of 89%. Conclusion Measurement of PSV-ITA by CFDU is a good diagnostic approach to discriminate between GD and thyroiditis, with sensitivity and specificity values comparable to those of 99mTc pertechnetate thyroid uptake.

Infantile Thiamine Deficiency: New Insights into an Old Disease

Context: The wide spectrum of clinical presentation in infantile thiamine deficiency is difficult to recognize, and the diagnosis is frequentlymissed due to the lack of widespread awareness, and non-availability of costly and technically demanding investigations. Evidenceacquisition: The topic was searched by two independent researchers using online databases of Google scholar and PubMed. Weconsidered the related studies published in the last 20 years. The terms used for the search were ‘thiamine’, ‘thiamine deficiency’, ‘beri-beri’, ‘B-vitamins’,‘micronutrients’, ‘malnutrition’, ‘infant mortality’. ‘Wernicke’s syndrome’,‘Wernicke’s encephalopathy’, and ‘lacticacidosis’. Results: In the absence of specific diagnostic tests, a low threshold for a therapeutic thiamine challenge is currently the bestapproach to diagnose infantile thiamine deficiency in severe acute conditions. The practical approach is to consider thiamine injection asa complementary resuscitation tool in infants with severe acute conditions; more so in presence of underlying risk factors, clinicallyevident malnutrition or where a dextrose-based fluid is used for resuscitation. Further, as persistent subclinical thiamine deficiency duringinfancy can have long-term neuro-developmental effects, reasonable strategy is to treat pregnant women suspected of having thedeficiency, and to supplement thiamine in both mother and the baby during breastfeeding. Conclusions: Health care professionals in thecountry need to be sensitized to adopt a high level of clinical suspicion for thiamine deficiency and a low threshold for the administration ofthiamine, particularly when infantile thiamine deficiency is suspected.

Post-thoracotomy ipsilateral shoulder pain: What should be preferred to optimize it - phrenic nerve infiltration or paracetamol infusion?

Background: Post thoracotomy ipsilateral shoulder pain (PTISP) is a distressing and highly prevalent problem after thoracic surgery and has not received much attention despite the incidence as high as 85%. Objectives: To study the effect of phrenic nerve infiltration with Ropivacaine compared to paracetamol infusion on PTISP in thoracotomy patients with epidural analgesia as standard mode of incisional analgesia in both the groups. Study Design: Prospective Randomised and Double Blind Study. Methods: 126 adult patients were divided randomly into 2 groups, “Group A (Phrenic Nerve Infiltration Group) received 10 mL of 0.2% Ropivacaine close to the diaphragm into the periphrenic fat pad” and “Group B (Paracetamol Infusion Group) received 20mg/kg paracetamol infusion” 30 minutes prior to chest closure respectively. A blinded observer assessed the patients PTISP using the VAS score at 1, 4, 8, 12 and 24 hours (h) postoperatively. The time and number of any rescue analgesic medication were recorded. Results: PTISP was relieved significantly in Group A (25.4℅) as compared to Group B (61.9℅), with significantly higher mean duration of analgesia in Group A. The mean time for first rescue analgesia was significantly higher in Group A (11.1 ± 7.47 hours) than in Group B (7.40 ± 5.30 hours). The number of rescue analgesic required was less in Group A 1.6 ± 1.16 as compared to Group B 2.9 ± 1.37 (P value <0.5). Conclusions: Phrenic Nerve Infiltration significantly reduced the incidence and delayed the onset of PTISP as compared to paracetamol infusion and was not associated with any adverse effects.

Protective effects of saffron against zearalenone-induced alterations in reproductive hormones in female mice (Mus musculus) / 대한생식의학회지

OBJECTIVE: Zearalenone (ZEA) is a mycotoxin with potent estrogenic effects. Saffron is an herbal product that has antioxidant activities. The objective of this study was to investigate the protective role of saffron against reproductive toxicity induced by ZEA in female mice. METHODS: Ninety 8-week-old female mice were randomly allocated into three treatment groups. The first group received an intraperitoneal injection of ZEA (2.5 mg/kg) on alternate days. The second group received ZEA (2.5 mg/kg) on alternate days plus oral saffron daily (50 mg/kg). The third group was treated with a vehicle of 1% dimethyl sulfoxide (DMSO) on alternate days, as a control. Ten mice were euthanized from each group at 30, 60, and 90 days of treatment. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), and progesterone (P) were assessed. The uterus and ovaries were examined for changes in size or morphology. RESULTS: Serum levels of LH, FSH, E2, and P in the female mice treated with ZEA plus saffron were significantly higher than in those treated with ZEA alone, and were not significantly different from those treated with 1% DMSO. The female mice treated with ZEA alone showed a reduction in size of the uterus and abnormal architecture of the ovaries. CONCLUSION: The administration of saffron to female mice resulted in a significant reduction in ZEA-induced alterations in reproductive hormone levels, the size of the uterus, and the morphology of the ovaries.

Prevalence of hepatitis C virus and its risk factors in blood donors in district Peshawar

The current study was designed in order to elucidate the most sensitive method for daily practice as well as to evaluate the risk factors for HCV infection associated with blood transfusion in District Peshawar. A total of 1400 healthy volunteer blood donors were tested for Anti-HCV. A questionnaire was used to evaluate the risk factors. Initial testing of all blood samples was done by Immuno Chromatographic Technique [ICT] and confirmed by micro particle enzyme immunoassay [MEIA] and Enzyme Linked Immunosorbent Assay [ELISA]. The comparison among ICT, ELISA and MEIA techniques was also evaluated for the purpose of sensitivity. Among 1400 blood donors, 26 [1.85%] cases were found positive for Anti-HCV. These 26 cases were positive on MEIA, 16 individuals were positive on ELISA while 14 were positive on ICT. These 26 cases had different histories of dental treatment [50%], traveled abroad [23.07%], surgery [11.53%], blood transfusion [7.69%] and unknown reason [7.69%]. Among all these different histories of dental treatment and blood transfusion were the main risk factors for HCV infection. The results revealed that MEIA ia a quick and reliable technique for routine screening of blood donors particularly for controlling the spread of HCV

Pharmacological activities of Justicia adhatoda

The current study focused on the pharmacological activities of Justicia adhatoda; including antibacterial, antifungal, phytotoxic, cytotoxic, haemagglutination, insecticidal, in vitro antiglycation, DPPH antioxidant and antitermite. The crude methanolic extract [Crd. Met. Ext] showed 46.4 % antibacterial activity against M. morganii while the n-hexane fraction showed good [71.4%] and moderate [55.1%] activity against M. morganii and A. baumannii respectively. The EtOAc and aqueous fractions, in most of the cases, showed low to no activity against the selected bacterial pathogens, against A. niger, T. harzianum, A. parasiticus and V. dahliae. The Crd. Met. Ext and fractions showed low activity, against P. notatum and P. digitatum, Crd. Met. Ext. and all fractions were inactive. The percent growth regulation, in case of phytotoxic activity, by Crd. Met. Ext was 25 and 16.6, n-hexane fraction 16.6, 16.6 and 0, CHCl3 25, 8.33 and 0 % and EtOAc fractions 8.33, 8.33 and 0% at 1000 and 100 and 10microg/ml respectively. The aqueous fraction was inactive at all the test concentrations. The results of brine shrimp cytotoxic activity for Crd. Met. Ext was 13.33% and n-hexane fraction 20% at 1000, microg/ml respectively. All of the other fractions showed low to no activity at different test concentrations. All of the test samples were inactive against RBC's of the blood groups at all concentration indicating that the selected plant lack phytolectins and haemagglutination activity. The Crd. Met. Ext and various fraction showed low activity against the test insects i.e. C. pulicaria, C. chinensis and T. castaneum. The absorbance value of plant extract for anti-glycation activity at various concentration were: 0.08, 0.067, 0.053 and 0.04 in comparison with Aminoguanidine0.04, 0.035, 0.03 and 0.02 respectively at 10, 50, 90 and 130microl. The DPPH radical scavenging activities were proportional to the concentration of the fractions, as the concentration of these increased, the percent scavenging activity also increased. The CHCl3 and EtOAc fractions killed all the termites in 24 hours while Crd. Met. Ext, n-hexane and aqueous fractions took 2-3 days

Investigation of Staphylococcus aureus, prevailing in the environment of Khyber Teaching Hospital, Peshawar, Pakistan

The hospital environment plays an important role in the spread of microorganisms, including multi drug resistant [MDR] strains. Patients can acquire Methicillin-Resistant Staphylococcus aureus [MRSA] which can reside in the clinical setup that are not cleaned and can spread through air droplets, bed clothing, and healthcare workers. The purpose of this study was to investigate the prevalence of S. aureus in the Khyber Teaching Hospital [KTH]. A total of 200 samples were collected from the floor, walls, air and inanimate objects in different wards of the KTH, during May 2012 to September 2012. These samples were screened for the recovery of S. aureus. Recovered organisms were subjected to susceptibility testing and investigated for the detection of various toxin and antibiotic resistance genes by Polymerase Chain Reaction [PCR]. A total of 64 samples yielded S. aureus, out of which 37 [57.81%] were proved as MRSA. No isolate was found resistant to Vancomycin, however 81.25% of the isolates were found susceptible to Linezolid and Amikacin. The susceptibility to Fusidic acid, Chloramphenicol, Rifampicin, Doxycycline and Meropenem was observed as 79.69%, 76.56%, 75.00, 73.44% and 68.75% respectively. The frequency of sea, seb and sec genes were 56.25%, 43.75% and 12.5% in the recovered isolates. Erm C was more prevalent [28.12 %] than the ermA and ermB. The prevalence of pvl in MRSA was 21.62 % which is less than 33.33% in the MSSA isolates. S. aureus and especially MRSA are frequently prevalent in the KTH. Therefore, every immune-compromised patient is prone to infections caused by S. aureus. This will lead to high morbidity/mortality rate, prolong hospital stay and add extra cost to the health system

Multidrug resistance reversal activity of extract and a rare dimeric naphthoquinone from Diospyros lotus

A dimeric naphthoquinone namely dihydrodyspyrole R [1] was purified once more from Diospyros lotus. Dihydrodyspyrole R and chloroform fractions were evaluated for their effects on the reversion of multidrug resistance [MDR]. The compounds [1] and extract exhibited promising MDR reversing effect in a dose-dependent manner against mouse T-lymphoma cell line. Molecular docking of compound 1 revealed the correlation between in-silico with in-vitro results. The molecular docking results showed that compound 1 is bind closely where co-crystal ligand of P-gp is present. But usually, computational investigation predicts that, if a compound gives lesser score then compound will exhibit good activity. Hence, the docking scores of compound 1 are the near to the Rhodamine. It is conclude that there are certain important structural features of compound 1which are responsible for the inhibiting potency of P-gp from mice. The computational Petra/Osiris/Molinspiration [POM] analysis confirms the possibility of use of compound 1 without side effect or less toxicity risks

In vitro activity of antimicrobial agents against streptococcus pyogenes isolated from different regions of Khyber Pakhtun Khwa Pakistan

The present study investigates the antibiotic resistance of S. pyogenes of 600 isolates collected from different body parts including throat and sputum were analyzed for their antimicrobial susceptibility to 5 antibiotics using the Kirby Bauer disc diffusion method. Based on different identification tests including, gram staining, beta hemolysis, catalase test and bacitracin sensitivity test, a total of 138 isolates were confirmed as S. pyogenes. The prevalence of S. pyogenes was 80% in sore throat and 29% in sputum samples. These isolates were further tested for antibiotics resistance using disk diffusion method. Out of 138 isolates, 49.27% isolates showed resistance towards cefixime, 28.98% towards cefotaxime and 17.39% towards ciprofloxacin, 17.39% towards ampicillin, 17.39% towards erythromycin, 15.94% towards streptomycin, 0.724% isolates towards chloromphenicol and 0% towards penicillin. Among the resistant isolates of S. pyogenes, 60.71% showed resistance towards cefixime, 57.14% towards ciprofloxacin, 57.14% towards streptomycin, 50% towards erythromycin and 25% towards cefotaxime

Report: antibacterial, antifungal, phytotoxic, antioxidant and hemagglutination activities of organic fractions of Arisaema tortuosum

In the current study, the antimicrobial, phytotoxic, haemagglutination and antioxidant potential of crude methanolic extract [Crd. MeOH Ext.] and four organic fractions of Arisaema tortuosum was investigated. All fractions have been screened for antimicrobial properties against eight bacterial pathogens and six fungal pathogens using agar well diffusion and tube dilution method, respectively. Furthermore, the organic fractions were also screened for its phytotoxicity against Lemna minor. Haemagglutination was performed against all human blood groups while free radical scavenging activity was performed to investigate the antioxidant potential of A. tortuosum. Results obtained for antibacterial activity exhibited various degree of zone of inhibition and significant activity was observed for Pseudomonas aeruginosa [27.16 +/- 0.60] followed by Bacillus cereus [18.55 +/- 0.69] for Crd. MeOH Ext. and chloroform [CHCl3] fraction, respectively while some strains showed resistant at same concentration. Similarly, non-significant antifungal activity was observed for the plant extracts. However, the highest activity among the strains was observed for Alternaria alternata [22 +/- 1.24%] and Aspergillus niger [20 +/- 1.00%] for ethyl acetate [EtOAc] fraction and Crd. MeOH Ext., respectively. The plant extracts showed good phytotoxic activity with 77.06% inhibition for n-hexane fraction at 1000microg/mL. The result of Nitric Oxide [NO] reducing assay revealed that the plant has less antioxidant activity with 46.06% inhibition for CHCl3 fraction at 900microg/mL. For haemagglutination assay, the result displayed no agglutination in all the testing concentration. Based on the current results, it can be concluded that A. tortuosum has significant antimicrobial and moderate phytotoxic potential and therefore can leads to antibiotics and herbicide production

Antibacterial activity of crude methanolic extract and various fractions of Vitex agnus castus and myrsine africana against clinical isolates of methicillin resistant staphylococcus aureus

Staphylococcus aureus is a nosocomial pathogen that resides in the soft tissues causing many diseases. The current study was conducted to determine the prevalence of Methicillin Resistant S. aureus [MRSA] in ear discharge and pus of patients and antibacterial activity of crude methanolic extract [Cr. MeOH Ext.] and various fractions of M. Africana and V. agnus castus against clinical isolates of MRSA. A total of 40 samples were collected from ear, nose and throat [ENT] outpatient department and wards of Khyber Teaching Hospital [KTH], Peshawar. Out of 40 samples, 36 [90%] samples showed growth on Mannitol Salt Agar [MSA] media out of which 9[25%] were MRSA and the remaining 27[75%] were methicillin susceptible S. aureus [MSSA]. A good antibacterial activity was observed for the Cr. MeOH Ext. [76.1%] and ethyl acetate [EtOAc] fraction of V. agnus castus against S[11] [71.4%]. The n-hexane fraction also showed good antibacterial effect [70%] against S[26]. The chloroform [CHCl[3]], butanol [BuOH] and aqueous fractions of M. africana showed good antibacterial activity against S[11] [71.4%], S[32] [70%] and S[26] [75%], respectively. The above results revealed that the selected plants can be further utilized for isolation of the active ingredients as the crude extracts were found good for inhibition of MRSA

Incidence of suicide in females of Faisalabad Tehsil

Background: suicide in females is an important and sensitive issue in our society. Suicide is one of the leading cause of death in both genders all over the world. The incidence and pattern of suicide in females vary from country to country. Religious and social values and legal issues play an important role in this regard. Since ours is a male dominating society and female rights are not observed properly as mentioned in Islam. Very few studies about the epidemiology of suicide in females have been conducted in Pakistan. We conducted this study on the patterns of suicide in females by the data of autopsies conducted at Faisalabad from 2002 to 2014. This study will give us an overview of the incidence of suicide in females, more vulnerable age group, most commonly used method and seasonal variation

Materials and Methods: the study includes 69 of suicidal deaths in females belonging to different age groups autopsied at the Department of Forensic Medicine, Punjab Medical College, Faisalabad. Cases were selected on the basis of information from the scene of crime, police inquest, autopsy findings and interview with the persons pertaining to the victim. Findings were tabulated and analyzed

Results: the study revealed that suicide rate in females was 0.401/100,000, the peak incidence was in age group 20-29 years followed by 10-19 years of age groups. Hanging was the most common method used. A seasonal surge in summer was noted

Conclusion: suicide in females of Faisalabad is much lower as compared to western countries. Female suicide occurs at a younger age in Faisalabad as compared to western countries

Biodistribution and kinetic studies of technetium-99m labeled Naja naja karachiensis venom via gamma scintigraphic and SPECT images

Naja naja karachiensis have been responsible for plentiful deaths in Pakistan. To investigate bio distribution and blood kinetics, venom was labeled with the radiotracer [technetium-99m] by following the method of direct labeling technique. Its maximum labeling percentage was 97.7% [pH 6, 100microg stannous chloride clihydrate] which was higher than some other reported venom. Radio labeled venom was stable for more than 4 hours both in vivo [96%] and in vitro [serum 94.1%, saline 94.3%] experimentations. Intravenous doses of venom [250microg, 0.5mCi] were found to be evenly distributed [having R/L ratio=1.0] in all parts of sacrificed rabbits. Kidneys [53.75% activity/g] and urinary bladder [23.70% activity/g] were found with the copious quantity of injected dose of venom. Rest of all other organs was found with subsequent remaining dose of venom. Among them, lungs [14.2% activity/g], liver [4.32% activity/g], bones [1.38% activity/g], heart [0.8% activity/g], blood]0.56% activity/g], skin[0.45% activity/g] intestines [0.35% activity/g], skeleton muscles [0.3% activity/g], brain [0.14% activity/g] and stomach [0.05% activity/g] are included. After 24 hours of injection, poisoned blood of rabbits was almost cleared from venom. Gamma scintigraphic images [up to 2 hours] along with bio distribution suggest that kidneys are main organs of excretion in rabbits. Elimination started immediately after administration of venom however, possible sites for metabolism of venom are liver and lungs. More accumulation of venom in heart compared to brain suggests its higher affinity [thus possible higher toxicity] to cardiac muscles as compared to brain tissues

Allgrove (Triple A) Syndrome: A Case Report from the Kashmir Valley

Allgrove (Triple A) syndrome is a rare autosomal recessive disorder characterized by cardinal features of adrenal insufficiency due to adrenocorticotropic hormone (ACTH) resistance, achalasia, and alacrimia. It is frequently associated with neurological manifestations like polyneuropathy. Since its first description by Allgrove in 1978, approximately 100 cases have been reported in the literature. Here we report an 18-year-old boy diagnosed as having Allgrove syndrome, with ACTH resistant adrenal insufficiency, achalasia, alacrimia, and severe motor polyneuropathy. Alacrimia was the earliest feature evident at the age of 8 years. He presented with achalasia and adrenal insufficiency at 12 and 18 years respectively and developed neurological symptoms in the form of severe muscle wasting at the age of 15 years. Patients with Allgrove syndrome usually manifest adrenal insufficiency and achalasia during first decade of life. Our patient manifested adrenal insufficiency and achalasia in the second decade and manifested neurological dysfunction before adrenal dysfunction.

NDM-1 (New Delhi metallo beta lactamase-1) producing Gram-negative bacilli: Emergence & clinical implications.

Backgound & objectives: resistance to carbapenems in Gram-negative bacteria conferred by NDM-1 is a global health problem. We investigated the occurrence of NDM-1 in clinical isolates of gram-negative bacilli in a tertiary care hospital in Kashmir valley, India. Methods: Gram-negative bacilli from different clinical isolates were included in the study. Antimicrobial susceptibility was performed by Kirby Bauer disk diffusion method and interpreted using Clinical Laboratory Standards Institute (CLSI) guidelines. Isolates resistant to carbapenems were subjected to different phenotypic test such as modified hodge test (MHT), boronic acid and oxacillin based MHT (bA-MHT and OXA-MHT), combined disk test and minimum inhibitory concentration (MIC) with imipenem and imipenem -EDTA for determination of class B metallo enzymes. Presence of blaNDM-1 gene was established by PCR and confirmed by sequencing. Results: Of the total 1625 gram-negative isolates received, 100 were resistant to imipenem. Of the 100 isolates, 55 (55%) were positive by modified Hodge test indicating carbapenemase production. Of the 100 isolates tested by MHT, BA-MHT and OXA-MHT, 29 (29%) isolates belonged to Class A and 15 (15%) to Class B, while 56 (56%) isolates were negative. Of the 15 class B metallo beta lactamase producers, nine carried the blaNDM-1 gene. NDM-1 was found among escherichia coli (2 isolates), Klebsiella pneumoniae (2 isolates), Citrobacter freundii (3 isolates), Acinetobacter spp (1 isolate), and one isolate of Pseudomonas aeruginosa. Isolates were resistant to all antibiotic tested except polymyxin B and tigecycline. Interpretation & conclusions: Our study showed the presence of clinical isolates expressing NDM-1 in Srinagar, Jammu & Kashmir, India. These isolates harbour plasmid mediated multiple drug resistant determinants and can disseminate easily across several unrelated genera. To halt their spread, early identification of these isolates is mandatory.

Quantitative and qualitative changes in human Meissner’s corpuscle at different ages: a light microscopic analysis.

Background: Meissner’s corpuscle is the most complex sensory receptors of the skin; providing information about rapidly fluctuating mechanical forces acting on the hairless skin. Aim of current study was to study density and structural changes in human Meissner’s corpuscles at different ages Methods: Samples were obtained from finger tips of fifteen persons and divided into three groups according to age: group A <15years; group B: 16-45 years and group C: 46-72 years. 5 μm thick sections were prepared, impregnated with silver and observed under compound light microscope. Density of Meissner’s corpuscles (Mcs) was studied by calculating Meissner’s Index (MI). Results: In group A, the MI was 0.86-0.90, which increased to 0.96 in group B and dropped in group C to 0.4 (in the seventh decade). The analysis of variance showed significant difference (P = 0.019) in MIs of the three age groups. The size of the Mcs was largest in group B, followed by group C and smallest in group A. The analysis of variance showed that there was highly significant difference (P = 0.003) between the size of Mcs in all the three age groups. It was observed that morphology of Mcs alter with age. In children these consisted of rudimentary coil of nerve fibers around collection of cells. In adults the intra-corpuscular nerve fibers were compressed into a tight spiral and modifications of nerve fibers, like end bulbs, varicosities and networks, were well developed. In old age Mcs were attenuated consisting of tangled mass of nerve fibers. Conclusion: It can be concluded that in adults the Mcs are greater in number, larger in size and complicated in structure, compared to young and old people.