Comparative study of the effectiveness between balancing exercises and strengthening exercises with common use of TENS to improve functional ability in Osteoarthritis involving knee joint.

Background and purpose: People with knee Osteoarthritis (OA) sometimes report episodes of knee instability that limit their activities of daily living. Proprioception and balance are important aspects of osteoarthritis treatment because of their strong correlation with function in the knee. The purpose of this study is to evaluate the effects of balancing exercises and strengthening exercises to improve functional ability in knee osteoarthritis patients and also it may be helpful to identify the use of best treatment protocol for OA knee. Material and methods: Thirty OA knee patients randomly allocated into two groups and received either balancing exercises (Group A) or strengthening exercises (Group B). Both the groups received TENS and taken treatment for 4 days a week for 4 weeks. The outcome measures were VAS and WOMAC. VAS was used to measure intensity of knee pain and WOMAC was used for assessment of perceived pain, stiffness and functional ability. Results: After 4 weeks of treatment, significant reduction in the WOMAC score and VAS was found in both the Groups. The result showing statistical improvement is more in Group A than Group B. Conclusion: The results of the study shows that balancing exercise is more effective than strengthening exercise to improve the functional ability of OA involving knee joint. The improvement in Group A is more than Group B and having statistically highly significant.

Anti - microbial resistance stratified by risk factor among Escherichia coli strains isolated from the urinary tract at a rural clinic in Central India.

Background: The failure of empirical therapy is frequently observed, even in community-acquired urinary tract infections. We, therefore, conducted a prospective, clinic-based study in 2004-2005 to document anti-microbial resistance rates and correlate them with possible risk factors to assist empirical decision-making. Materials and Methods: Symptomatic patients with pyuria underwent urine culture. Isolates were identified using standard methods and anti-microbial resistance was determined by disk-diffusion. Ultrasonography was used to detect complicating factors. Patients were stratified by the presence of complicating factors and history of invasive procedures for comparison of resistance rates. Statistical Method Used: Chi-square or Fisher exact tests, as appropriate. Results: There were 156 E. coli isolates, of which 105 were community-acquired. Twenty-three community-acquired isolates were from patients with complicating factors while 82 were from patients without any. Fifty-one isolates were from patients who had recently undergone invasive procedures on the urinary tract. Thirty-two community-acquired isolates from reproductive-age women without apparent complicating factors had resistance rates of 50% or above against tetracyclines, Co-trimoxazole, aminopenicillins, Nalidixic acid, Ciprofloxacin and 1 st generation cephalosporins. Resistance rates were significantly higher among isolates from patients subjected to invasive procedures, except against Co-trimoxazole, tetracyclines and Amikacin. Conclusion: High rates of anti-microbial resistance in community-acquired uropathogens have made antimicrobial sensitivity testing necessary even in a rural, primary-care setting.

Ficus cunia agglutinin for recognition of bacteria.

Interaction of bacteria with lectin using anti-lectin antibody by ELISA is an established method. In the present study, we have devised a simple ELISA using a biotinylated lectin and antibiotin-HRP. Ficus cunia agglutinin (FCA), which has shown the specificity towards alpha/beta anomers of GlcNAc and other-NAc containing sugars like LacNAc and GlcNAcbeta(1-4/6)GlcNAc, was used as a model lectin for the study of interaction with immobilized microorganisms on ELISA plate. The bacterial cells of E. coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Bacillus subtilis and Staphylococcus aureus showed binding with FCA and the degree of binding was dependent on the bacterial surface antigen. This method is considered a simple technique to study the lectin-bacteria interaction.

Differential organization of a LINE-1 family in Indian pygmy field mice.

Southern blot hybridization analysis of genomic DNAs digested with restriction endonuclease EcoR I and Ava II from Mus musculus domesticus, Mus booduga and Mus terricolor with a cloned repetitive DNA fragment of Mus booduga as a probe showed difference in restriction pattern of this DNA in these three species. Further Southern analysis of the BamH I digested genomic DNAs from these species hybridized with cloned DNA fragment as a probe and sequencing of the cloned DNA revealed that this 252 bp cloned DNA fragment is a part of BamHI repeat element of genus Mus and is 87% homologous to the contiguous portion of the Mus musculus domesticus LINE-1 element. The species specific fragment pattern generated by different restriction endonucleases using this DNA as a probe revealed difference in the organization of LINE-1 repetitive element in the three species of genus Mus.

Heart rate variability in dilated cardiomyopathy.

Chronic heart failure is associated with excessive neurohormonal activation. Analysis of heart rate variability is considered a valid technique for assessment of the autonomic balance of the heart. Twenty symptomatic patients of dilated cardiomyopathy in NYHA class II-IV symptomatic status and as many normal controls were subjected to 24 hours Holter monitoring to assess the heart rate variability with both time domain and frequency domain analysis. Age of the patients ranged from 12 to 67 years (mean +/- SD 38.6 +/- 7 years), the male-female ratio was 4:1. The left ventricular ejection fraction of the patients was between 18-42 percent (mean +/- SD 30.2 +/- 9%) and all received diuretics, digoxin and angiotensin-converting enzyme inhibitors. Heart rate variability parameters measured included mean heart rate with standard deviation, hourly heart rate with SD and the mean of all normal RR intervals from the 24-hour recording. Time domain measures calculated were SD of all normal RR intervals, SD of 5 minute mean RR intervals and root mean square of difference of successive RR intervals. Using spectral plots, frequency domain subsets of low frequency and high frequency were analysed and expressed in normalised units. Total power was also measured. In the dilated cardiomyopathy patients, mean 24-hour heart rate in beats per minute was significantly higher in comparison to controls (82 +/- 13 vs 72 +/- 8; p < 0.001) whereas mean hourly heart rate with standard deviation (msec) was significantly lower (97 +/- 41 vs 232 +/- 25; p < 0.001), SD of all normal RR intervals (msec) was 85.5 +/- 26.3 vs 139.4 +/- 16.9 in controls (p < 0.001), SD of 5 minute mean RR intervals (msec) was also significantly less in patients in comparison to controls (75.8 +/- 39.6 vs 130.8 +/- 20.3; p < 0.001). However, although root mean square of difference of successive RR intervals (msec) was reduced in patients (30.1 +/- 9.3 vs 37.3 +/- 11.7; p < 0.05), the difference was non-significant. Low frequency power (0.05-0.15 Hz) (normalised units) was reduced in the dilated cardiomyopathy group (0.0721 +/- 0.003 vs 0.136 +/- 0.047 in the control group; p < 0.001). High frequency power (0.35-0.50 Hz) (normalised units) (0.08 +/- 0.05 in patients vs 0.09 +/- 0.02 in controls; p > 0.1) and total power frequency (0.02-0.50 Hz) (normalised units) (0.34 +/- 0.05 in patients vs 0.35 +/- 0.12 in controls; p > 0.1) was non-significantly different in the two groups. Regression analysis showed a significant decrease in SD of all normal RR intervals, SD of 5 minute mean RR intervals, low frequency, high frequency, total power and a non-significant decrease in root mean square of difference of successive RR intervals with a decrease in ejection fraction percent whereas there was a significant decrease in SD of all normal RR intervals, SD of 5 minute mean RR intervals, low frequency and total power and a less significant decrease in root mean square of difference of successive RR intervals and high frequency power with an increase in NYHA class. At 6 months duration, 6 patients were lost to follow-up, 3 patients were readmitted (2 for congestive cardiac failure, one of paroxysmal supraventricular tachycardia). One patient who was NYHA class IV at baseline was readmitted for congestive cardiac failure and showed much lower heart rate variability parameters compared to the average of the patients. We conclude that in symptomatic dilated cardiomyopathy patients, heart rate variability parameters are significantly reduced in comparison to control subjects.

Isolated myoepithelial duodenal hamartoma presenting with upper gastrointestinal bleed.

Myoepithelial duodenal hamartoma, a rare lesion, usually occurs as a part of diffuse gastrointestinal tract polyposis in Peutz-Jegher's and Gardner's syndromes. Solitary duodenal hamartoma in the absence of other manifestations of polyposis syndrome is rare. We report one such patient presenting with massive gastrointestinal bleeding.

A clinicobacteriological study on leucorrhoea.

The pathogens like Trichomonas vaginalis (4.5%), N gonorrhoeae (2.7%) and C albicans (6.7%) were exclusively present in leucorrhoea. The other potential agents with their respective percentages in normal women and cases of leucorrhoea were U urealyticum (21.2% and 50.2%), actinomyces (29.7% and 41.6%), Chlamydia trachomatis (17% and 48.8%), candida-like organisms (CLO) (1.2% and 9.5%) and non-group B streptococci (4.2% and 16.7%). The percentages of urethral syndrome (65.8%), vaginal irritation (63.4%), sore vulva (17%), cervicitis (13.4%), cervical erosion (11%) of the STD clinic were more than those of gynaecological cases. The latter group more often revealed infertility (15.8%) and pelvic inflammatory disease (13.6%). The exclusive isolation rate of N gonorrhoeae (7.3%) and prevalence of G vaginalis (19.5%) and Trichomonas vaginalis (8.5%) in the STD clinic were notable. The cases of gynaecological clinic more commonly showed C albicans (8%) and CLO (13.6%). Significant differences pertaining to U urealyticum (leucorrhoea and inapparent group p < 0.01; leucorrhoea and normal cases p < 0.01), M hominis (leucorrhoea and inapparent group p < 0.05; leucorrhoea and normal cases p < 0.01), Chlamydia trachomatis (leucorrhoea and normal cases p < 0.01) and also actinomyces (leucorrhoea and normal cases p < 0.01; inapparent and normal cases p < 0.05) were recorded. There was conspicuous association of U urealyticum, M hominis, G vaginalis, Chlamydia trachomatis, CLO and actinomyces with leucorrhoea. An almost exclusive presence of Staph aureus, Esch coli and Klebsiella in cases of leucorrhoea appeared meaningful.

ERCP in situs inversus: do we need to turn the other way?

Endoscopic procedures are difficult in patients with situs inversus owing to left-right reversal of viscera. Conventionally, reversal of the position of the endoscopist in relation to the patient is advocated to overcome the anatomical difficulty. We describe a patient with chronic calcific pancreatitis and pseudocyst of the pancreas who had situs inversus. ERCP was performed with minor modification of maneuvers with the patient in the usual left lateral decubitus and the endoscopist on the left of the table.

Inhibition of bacterial respiration by a low-molecular weight lectin, scyllin, from Scylla serrata crab hemolymph.

Interaction of plant and/or invertebrate lectins with mammalian cells and different microorganisms is well known. In the present study, we have demonstrated that scyllin, a low molecular weight (MW 4000) lectin from the edible crab Scylla serrata hemolymph, purified by GalNAc-Sepharon affinity column followed by Mono-Q ion exchanger in FPLC exhibits antimicrobial activity against Bacillus cereus and Escherichia coli by inhibiting endogenous respiration as well as exogenous glucose oxidation. In both the cases oxygen consumption has been measured in an oxygraph. Scyllin has produced 50% inhibition of endogenous respiration at a concentration of 110 micrograms/ml and 125 micrograms/ml in B. cereus and E. coli respectively. It also reduced the exogenous glucose oxidation by 50% at a concentration of 12 micrograms/ml and 80 micrograms/ml respectively in B. cereus and E. coli. From the above study the mechanism of bacterial growth inhibitory property of scyllin is suggested though the other studies such as inhibition of nucleic acid biosynthesis, cell wall biosynthesis etc. to evaluate its total mode of inhibitory action are not yet obtained.

HPV 16 DNA sequences in different grades of cervical lesions.

A simple rapid method for isolation of genomic DNA from cervical scrape cells has been standardized. Sufficient amount of good quality genomic DNA was isolated from each cervical scrape specimen. Total 120 cervical scrape specimens from wide spectrum of cervical lesions were analysed for the presence of HPV 16 DNA by Southern hybridization using 32P labelled HPV 16 DNA as probe under stringent conditions. Viral DNA sequences were detected in 78 of the specimens. About 36% (5 out of 14) of normal cervical smears and 59% (46 out of 78) of inflammatory cervical smears had the viral DNA sequences. Except a lone sample, the rest 27 samples of different grades of dysplasia specimens and squamous cell carcinoma samples had viral DNA sequences. Due to development of sensitive Southern hybridization method, the presence of HPV 16 DNA could be detected in high percentage of specimens belonging to the inflammatory cervical specimens.

Pathogenic potential of Gardnerella vaginalis on the female urogenital system.

The prevalence of certain characteristics of genital discharge like (a) watery variety in sexually transmitted disease (STD) clinic 34% and in gynaecology clinic 26.6%, (b) fishy odour in STD clinic 29.2% and in gynaecology clinic 12.2% and (c) pH > 4.5 in STD clinic 53.6% and in gynaecology clinic 43% was notable. On the other hand, occurrence of "clue cells" (in STD clinic 41.4% and in gynaecology clinic 39.5%) did not show difference in the aforesaid clinics. The preponderance of watery discharge in the STD clinic appears to be related to G vaginalis (in STD clinic 26.8% and in gynaecology clinic 9.3%). It is intriguing to note that G vaginalis was isolated from leucorrhoea (in STD clinic 19.5% and in gynaecology clinic 9.3%) and inapparent (in 10%) cases and normal (in 4.2%) cases. Single infection with G vaginalis in one particular case had profuse watery discharge, pH > 4.5 and there was occurrence of "clue cells". Likewise, in multiple infections revealing G vaginalis (29 cases) as one of the potential agents, 78.5% had profuse, 53.8% watery discharge of which 53.5% had "clue cells" and 81% had pH > 4.5. In mixed type of infections, the U urealyticum (53.8%) and M hominis (30.6%) were conspicuous in bacterial vaginosis. Cervicitis, erosion cervix or urethral syndrome were unrelated to G vaginalis. All cases of G vaginalis infection responded to metronidazole with remission of leucorrhoea in 25.9% cases.

Non-sporing anaerobes in certain surgical group of patients.

The magnitude of non-sparing anaerobic (NSA) infections has been defined in the postoperative wounds on colorectum in children (57.1%), general surgery (0%), abdominoperineal and uterocervical operations (11-45%) in gynaecologic and obstetrical cases and perforative peritonitis (25.8-32.3%). Children below the 6 months age group bear less risk of acquiring NSA infection. Under certain situations, metronidazole combats NSA infections in a better way than other antibacterials. The bacteriology of NSA infections has been probed at the species level in the gynaecologic and obstetrical patients. The species of normal cervix (44.6%) are represented in wounds involving abdominal wall (11%), perineum (22.8%) and uterocervix (45.6%) to suggest endogenous infection. Out of the 22 species of NSA isolated, Peptostreptococcus anaerobius, Acidaminococcus fermentans and Peptococcus prevotii are the commonest. Others were Peptococcus niger, Gaffkya anaerobia, Lactobacillus bulgaricus, Actinomyces bovis, Bacteroides oralis, Fusobacterium gonidiaformans and the different species of peptococcus, peptostreptococcus, eubacterium, propionibacterium and fusobacterium. The weight of evidence indicated a pathogenic role of Peptostreptococcus anaerobius and Ruminococcus flavefaciens, in view of their heavy growth. The umbrella of antibacterials reduced Gram-positive anaerobic cocci from 40% to 16%. The facultative anaerobes Staph aureus, Staph epidermidis, Kl pneumoniae and proteus appeared as the exogenous agents of nosocomial infections.

Cocos nucifera pollen inducing allergy: sensitivity test and immunological study.

Among the heterogeneous population (n = 975) in greater Calutta, sensitization to Cocos nucifera pollen accounts to be 2.65% and for atopic patients (n = 204) 47.06%. Out of 24 patients who had C. nucifera pollen sensitivity and suffered from asthma and allergic rhinitis, 16 showed sensitivity also to other allergens. All were skin test positive and 19 of them were phadezym RAST positive to C. nucifera pollen extract. Bronchial provocation test appeared to be positive in 7 out of 8 patients included in the test and no late response or non-specific reactions were observed. C. nucifera pollen extract on fractionation by ion-exchange chromatography following gel filtration yielded two major allergenic protein fractions, CnII (M(r) 158,000) and CnVII (M(r) 2900) as evidenced by skin prick test, ELISA-inhibition and immunoblot analysis. Hence, C. nucifera pollen should be considered to be a relevant allergen and thus included in the panel of allergens for routine clinical use.

Bacteria in surface infections of neonates.

A bacteriological work on surface infections was done among live births (study group I) and neonates admitted in hospital (study group II). Out of 134 cases of conjunctivitis in group I Gram-negative bacilli predominated (48.5%) with Escherichia coli accounting for 29 (14.9%) cases, Klebsiella species 15 (11.2%) cases, Citrobacter freundii 3 (2.2%) cases, Pseudomons aeruginosa 18 (13.4%) cases and Aeromonas hydrophila 3 (2.2%) amongst pure isolates (73.9%). Gonococcus was noted in 2 (1.5%) cases. In group II, 41.7% were Staphylococcus aureus in pure growth (75%), compared to only 9.0% in group I. Skin infections were caused by both Staphylococcus aureus and Staphylococcus epidermidis. Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were the principal insolates from umbilical sepsis. Pseudomonas aeruginosa was isolated as pure growth from local site of noma neonatorum. Anaerobic cultures were negative in all except in 2 cases of umbilical sepsis with tetanus neonatorum revealing Clostridium tetani which however proved to be non-toxigenic. Blood cultures were positive in 4 out of 14 cases bearing 50% correlation with bacteria from surface infections. A source study established partial correlation with the cases of pseudomonas conjunctivitis. Phage typing of Staphylococcus aureus and biochemical typing failed to detect any definite marker of clinical entities, except that the skin infections were caused by group III phages predominantly (65.0%).

Amplification of mitochondrial DNA fragment by PCR: comparison of linear and circular DNA.

Amplification of circular and linear mitochondrial DNAs (mtDNA) has been checked by PCR using two thermostable polymerases. The results demonstrated that while Taq polymerase could amplify both circular and linear mtDNAs, the Vent polymerase can only amplify linear DNA.

Rapid diagnosis of anaerobic gram-positive cocci by salt tolerance.

The maximum salt tolerance was 2.5% in cases of Peptostreptococcus anaerobius and Peptococcus prevotii, 3% in Ruminococcus albus, 4% in Acidaminococcus fermentans, Peptococcus niger and Megasphaera elsdenii and 5% in Peptococcus magnus. The biochemical tests being largely inactive and time consuming the findings of salt tolerance if combined with those of morphological data provide clue to the rapid identification of Gram-positive anaerobic cocci.