Report-based antibiotic sensitivity pattern of community-acquired urinary tract infection in rural Bengal

Background: Urinary tract infection (UTI), a common bacterial infection managed in general practice, is the second most common cause for antibiotic use in primary care setting. Antibiotic prescription is mostly empirical in UTI and it is imperative to choose one highly sensitive drug against the common pathogens. Aims and Objectives: In this study, it has been tried to find out the magnitude of community-acquired UTI in a rural population of West Bengal, its causative agents, and the sensitivity pattern of urinary isolates to reduce the development of antibiotic resistance. Materials and Methods: This is an observational, cross-sectional study over 1 year in a rural tertiary care hospital in West Bengal. Culture and sensitivity reports generated from diagnosed UTI patients from the different OPDs of the hospital were analyzed. Results: Out of 603 reports analyzed, culture-positive reports were 463. Escherichia coli was identified to be the most predominant (61.7%) followed by Staphylococcus aureus (17.3%). The sensitivity report of the empirically given antibiotics shows that among the oral antibiotics, nitrofurantoin was the most sensitive one (92%) followed by ciprofloxacin (83.1%) and ofloxacin (66%). Among the injectables, amikacin (84.5%) and ceftazidime (81.8%) were the antibiotics having the highest sensitivity. Conclusion: The sensitivity among the uropathogens to the commonly used antibiotics shows higher resistance rate toward norfloxacin, cephalexin, cotrimoxazole, ampicillin, amoxicillin, co-amoxiclav, and cefuroxime. Oral antibiotics such as nitrofurantoin and ciprofloxacin and parenteral antibiotic amikacin have found to be of higher sensitivity among all organisms identified clubbed together.

Reflective writing as a learning tool for Phase II MBBS students in India

Background: Reflection is essential in training physicians mainly because it helps them to participate in collaborative teams, respond in unique and compassionate manner to clinical cases and situations and behave professionally and with empathy. Aims and Objectives: The objective of this study was to observe the reflective writing ability of the Phase II MBBS students of the institute after a structured training and to obtain student feedback about the experience. Materials and Methods: This was a prospective, observational study conducted at the Department of Pharmacology, of a Medical college. A total of 102 students were included in an interactive lecture on reflection writing. Over 3 weeks they were shown three different videos (two of them doctor patient/family member interactions and one a teacher student interaction). The students were asked to reflect about what they saw in the videos. Their reflection was under three heads - “what happened, what was your reaction, and what can be done next.” Their reflection was analyzed using a scoring system (score 1 no refection to score 6 with in depth reflection) by a single observer. Their feedback was obtained using a 5-point Likert scale. Results: Average scores of the students in the three reflection exercises were 2.85 ± 0.78, 2.98 ± 0.84, and 3.36 ± 0.57, respectively, showing improvement in reflection skills. Feedback from the students showed that most liked the experience and recommended for their peers. Conclusions: We concluded that 2nd year MBBS students, when taught the structure of a reflective exercise may be able to reflect better on their day to day experiences.

Basal cell carcinoma-clinico-pathological study in Eastern India in correlation with different risk factors

Objectives: To study the histological variants and mimickers of basal cell carcinoma (BCC) alongwith different risk factors among a group of patients from eastern India. Methods: The specimen for the study was sent by the dermatology department for histopathology after skin biopsy. Results: Out of 42 patients, 15 patients studied were males and the rest of the cases were females. The male to female ratio was 0.55:1. Maximum (15 cases) cases were in the age group of 50–59 years. Apart from sunlight, chronic arsenic exposure is an important risk factor of BCC. Basal cell hyperplasia and squamous cell carcinoma are the histological differential diagnosis of nodular BCC and basosquamous BCC. Conclusion: BCC is a disease of the older age group and with female preponderance in our study. Nodular basal cell carcinoma was the most common histologic type of basal cell carcinoma. The face was the most common site for BCC followed by the scalp. UV radiations and Arsenic do play role in the pathogenesis of BCC. CD10 helps differentiate superficial BCC from basal cell hyperplasia.

Verbal learning in schizophrenia in remission, first-degree relatives, and correlation to symptoms

Background: Cognitive impairments are fundamental in schizophrenia with verbal memory impairments commonly occurring not only in patients but also in unaffected genetically susceptible individuals. Deficits in verbal memory produce difficulty in problem-solving, emotional distress, and worsening of daily life skills resulting in a poor quality of life. Objectives: This study aims to evaluate the verbal memory in unaffected first-degree relatives of patients of schizophrenia in comparison to healthy controls as well as patients of schizophrenia in remission and to find correlation to symptom domains. Methods: It was a hospital-based, descriptive, cross-sectional case-control study. Three groups (n=40, each group) of patients, first-degree relatives, and controls were taken. Subjects were screened for mental retardation and remission was ascertained in the patient group by the Positive and Negative Syndrome Scale (PANSS). Rye’s Auditory Verbal Learning (RAVL) test was used to assess verbal leaning. Results: Verbal memory impairments were significant both in patients and unaffected first-degree relatives. Further, these impairments showed a strong correlation to negative symptoms. Conclusion: Significant (p<0.05) verbal learning impairments were noted in patients and first-degree relatives which showed a correlation to negative symptoms.

High-intensity exercise-induced oxidative stress in sedentary pre-pubertal & post-pubertal boys: A comparative study

Background & objectives: High-intensity exercise results in oxidative stress in adult population. Impact of pubertal attainment on high-intensity exercise-induced oxidative stress in sedentary paediatric population has not been investigated in detail. The present study was conducted to investigate the extent of high-intensity exercise-induced oxidative stress in sedentary pre- and post-pubertal boys through estimation of serum thiobarbituric acid reactive substances (TBARS), total thiol content and activities of superoxide dismutase (SOD) and catalase (CAT). Methods: Sixty four sedentary pre-pubertal (n=32, age = 10.21�67 yr) and post-pubertal (n=32, age = 15.58�47 yr) boys performed incremental treadmill running exercise at 80 per cent of the age predicted maximum heart rate till volitional exhaustion. Blood sample (5 ml) was drawn from each individual before and after the exercise for estimation of oxidative stress markers. Results: Pre-exercise SOD activity and total thiol level showed significant positive relationship with age and were significantly higher in post-pubertal boys. Serum TBARS level, SOD and CAT activities increased while total thiol content decreased in both the groups following exercise. Post-exercise percentage change in TBARS, SOD activity and total thiol level was significantly higher in post-pubertal boys, and these variables had significant positive relationship with age. No significant intergroup variations were noted in CAT activity before or after exercise. Interpretation & conclusions: Extent of post-exercise oxidative stress increased significantly with attainment of puberty. However, baseline and post-exercise antioxidation status also increased significantly as a function of age with pubertal maturation allowing the post-pubertal boys to counter relatively higher oxidative stress more efficiently than their pre-pubertal counterparts. Post-exercise upregulation in CAT activity might not be influenced by age or pubertal maturation in this age group.

Sero-prevalence of Rubella Antibodies in Pregnant Women with Bad Obstetric History Attending A Rural Tertiary Care Hospital in West Bengal, India

Background: Rubella infection in pregnant mothers is of great concern as it acts as a teratogen causing abortions, still births, intra-uterine foetal deaths and multiple birth defects. In India, rubella causes significant bad obstetric pregnancy outcome including congenital deformities due to lack of proper surveillance and immunization coverage with rubella vaccination. Aim: To determine Sero-prevalence of rubella IgM and IgG antibodies in Bad Obstetric History (BOH) pregnant women in Tertiary Rural Medical College in Eastern India. Materials and Methods: Cross sectional study was conducted from 1st January 2017 to 31st March 2017 on sera of 100 antenatal mothers with bad obstetric history aged between 20-40 years of age group with pregnancy of ≥18 wks. Rubella IgM and IgG antibodies were assessed by ELISA. Statistical Analysis: Percentage, proportions and ᵡ2 test were applied. Results: Eleven per cent (11%) sero-prevalence for IgM antibodies and 54% for IgG antibodies was observed with maximum sero-positivity among 20-25 years mothers. Repeated abortions were the commonest pregnancy outcome. Conclusion: All antenatal cases should be routinely screened for rubella, so that early diagnosis will help in proper management and foetal outcome and strong recommendation for universal coverage of MMR in early age group of children.

Sero-prevalence of Rubella Antibodies in Pregnant Women with Bad Obstetric History Attending A Rural Tertiary Care Hospital in West Bengal, India

Background: Rubella infection in pregnant mothers is of great concern as it acts as a teratogen causing abortions, still births, intra-uterine foetal deaths and multiple birth defects. In India, rubella causes significant bad obstetric pregnancy outcome including congenital deformities due to lack of proper surveillance and immunization coverage with rubella vaccination. Aim: To determine Sero-prevalence of rubella IgM and IgG antibodies in Bad Obstetric History (BOH) pregnant women in Tertiary Rural Medical College in Eastern India. Materials and Methods: Cross sectional study was conducted from 1st January 2017 to 31st March 2017 on sera of 100 antenatal mothers with bad obstetric history aged between 20-40 years of age group with pregnancy of ≥18 wks. Rubella IgM and IgG antibodies were assessed by ELISA. Statistical Analysis: Percentage, proportions and ᵡ2 test were applied. Results: Eleven per cent (11%) sero-prevalence for IgM antibodies and 54% for IgG antibodies was observed with maximum sero-positivity among 20-25 years mothers. Repeated abortions were the commonest pregnancy outcome. Conclusion: All antenatal cases should be routinely screened for rubella, so that early diagnosis will help in proper management and foetal outcome and strong recommendation for universal coverage of MMR in early age group of children.

trans-4,4'-Dihydroxystilbene (DHS) protects PC12 cells from oxidative damage but induces reactive oxygen species-mediated apoptosis in SHSY-5Y cell line.

Polyphenols can exert both, antioxidant and pro-oxidant properties, depending on cell types as well as their concentrations. Hence, it was of interest to examine if the naturally occurring resveratrol analog, trans-4,4'-dihydroxystilbene (DHS) also exert both these activities in a biphasic or cell-specific manner. In this study, we established the cytoprotective action of DHS against hydrogen peroxide (H2O2)-induced apoptotic death of the PC12 cells. DHS reduced mitochondrial membrane permeabilization and deactivated reactive oxygen species (ROS)-mediated caspase-3 activation in the H2O2-treated PC12 cells. However, it induced apoptosis in the human neuroblastoma SHSY-5Y cell line by destabilizing mitochondrial membrane, augmenting ROS and activating caspapse-3. DHS showed better activity than resveratrol in both the chosen models.

Chikungunya virus infection in West Bengal, India.

Background: Chikungunya virus has recently re-emerged in India. Objectives: Assess prevalence of Chikungunya. Materials and Methods: Study conducted from April 2011 to September 2011. Two hundred and six patients (206) of both sexes (100 males and 106 females) of all age groups studied. Serum separated and CHIKV MAC IgM ELISA and Hemagglutination inhibition assay done. Results: 76 cases (36.89%) sero-positive by both the methods. Conclusion: Re-emergence and resurgence of the Chikungunya virus requires continuous monitoring.

Religion, spirituality, health and medicine: why should Indian physicians care?

Religion, spirituality, health and medicine have common roots in the conceptual framework of relationship amongst human beings, nature and God. Of late, there has been a surge in interest in understanding the interplay of religion, spirituality, health and medicine, both in popular and scientific literature. A number of published empirical studies suggest that religious involvement is associated with better outcomes in physical and mental health. Despite some methodological limitations, these studies do point towards a positive association between religious involvement and better health. When faced with disease, disability and death, many patients would like physicians to address their emotional and spiritual needs, as well. The renewed interest in the interaction of religion and spirituality with health and medicine has significant implications in the Indian context. Although religion is translated as dharma in major Indian languages, dharma and religion are etymologically different and dharma is closer to spirituality than religion as an organized institution. Religion and spirituality play important roles in the lives of millions of Indians and therefore, Indian physicians need to respectfully acknowledge religious issues and address the spiritual needs of their patients. Incorporating religion and spirituality into health and medicine may also go a long way in making the practice of medicine more holistic, ethical and compassionate. It may also offer new opportunities to learn more about Ayurveda and other traditional systems of medicine and have more enriched understanding and collaborative interaction between different systems of medicine. Indian physicians may also find religion and spirituality significant and fulfilling in their own lives.

Dural biopsy-- an important prognostic indicator in tuberculous meningitis with hydrocephalus following shunt surgery.

This study has been carried out in the department of paediatric surgery, Medical College and Hospital, Kolkata, with an aim to prognosticate the postoperative outcome of the patients of hydrocephalus following tuberculous meningitis after placement of ventriculoperitoneal shunt. Amongst various variables, clinical grading at the time of operation was thought to be an important predictor for outcome following ventriculoperitoneal shunt, but unfortunately remained unpredictable in final outcome in many patients. In the present study, pre-operatively the patients were first graded clinically. In an attempt to prognosticate these patients, a tiny piece of dura was taken during placement of the ventriculoperitoneal shunt from the site of insertion of the shunt and the sample was sent for histopathological examination. Histopathological findings were classified as healthy dura and unhealthy dura (with cellular infiltration, fibrosis and calcification) and correlated with the postoperative clinical outcome. Out of total 28 patients treated from June, 2001 to September, 2005, 19 patients showed healthy dura and 9 patients showed unhealthy dura. Results in this study reveal that postoperative recovery and long term outcome of the patients with healthy dura are better and that of unhealthy dura are poor irrespective of pre-operative clinical grading. Fourteen (74%) out of 19 patients who had healthy dura improved satisfactorily whereas only 1 out of 9 patients who had unhealthy dura improved satisfactorily.

An unusual presentation of medial sphenoid wing meningioma.

A young woman of 26 years attended eye OPD with the complaints of complete and rapid loss of vision of her righ eye and progressive dimness of vision of left eye, frontal headache and nausea for last two months. On eye examination, she was found to have no perception of light to her right eye. Ophthalmoscopy examination revealed primary optic atrophy in right eye and marked papilloedema to her left eye. CT scan of brain showed space occupying lesion in right parasellar region with sellar and suprasellar extension with involvement of right anterior clinoid process suggesting medial sphenoid wing meningioma. The patient underwent surgery and the histopathology proved the diagnosis as meningioma. The case of medial sphenoid wing meningioma in a young female producing rapid Foster Kennedy syndrome is reported for its unusual presentation.

Effects of hypothyroidism induced by 6-n-propylthiouracil and its reversal by T3 on rat heart superoxide dismutase, catalase and lipid peroxidation.

The present study critically evaluates the effects of hypothyroid and hyperthyroid states on lipid peroxidation and two enzymes of active oxygen metabolism, namely superoxide dismutase (SOD) and catalase (CAT) in the rat heart mitochondrial and post-mitochondrial fractions. Lipid peroxidation, an index of oxidative stress, was elevated in the heart tissue in hypothyroid state but reduced upon T3 supplementation. Hyperthyroidism registered increased SOD activity in post-mitochondrial fraction. Mitochondrial SOD activity was reduced in hypothyroid state, which was further reduced by T3 administration. In contrast, different thyroid states had no effect on catalase activity in the mitochondrial fraction. The hypothyroid state however, significantly augmented catalase activity in post-mitochondrial fraction. The results suggest that the antioxidant defence status of cardiac tissue is well modulated by thyroid hormone.

Estimation of vacuolating cytotoxin secreted by different strains of Helicobacter pylori using bead enzyme-linked immunosorbent assay & its correlation with bacterial genotype.

BACKGROUND & OBJECTIVES: A highly sensitive bead enzyme-linked immunosorbent assay was applied for the quantitative determination of vacuolating cytotoxin (VacA) released in the culture supernatant of 40 well characterized Helicobacter pylori strains in order to clarify the significance of allelic combination of the vacA gene as the predictor of the level of toxin secretion and also to determine the most appropriate genotype of H. pylori associated with high VacA release. Attempts were also made for the detection of VacA in the gastric juice of patients for the rapid diagnosis of H. pylori infection. METHODS: The genotypes of 40 H. pylori strains cultured from the gastric biopsy samples were determined by specific PCRs. The cell-free culture supernatant of the strains as well as the gastric juice of the patients were used for bead-ELISA and the purified VacA from the H. pylori strain ATCC49503 was used as positive control. RESULTS: Ninety per cent of the strains with vacAs1m1 allele combination secrete on an average 146.4 ng/ml of VacA while the corresponding value was 19.1 ng/ml for s1m2 strains. None of the s2m2 as well as the ice negative H. pylori strains produced detectable VacA in the medium while strains expressed the toxin irrespective of the presence or absence of cagA gene. Fifteen of 22 gastric juice samples yielded positive bead-ELISA results. INTERPRETATION & CONCLUSION: vacAs1, vacAm1 and iceA1 could be considered as the determinants of high VacA secretion. Also, the detection of VacA by bead-ELISA in the gastric juice could be considered as an alternative approach in the diagnosis of H. pylori infection.

Identification of human proteins using the linguist's tools.

The symbolic sequences of the exons that make human proteins are subjected to methods of statistical linguistics. The ideas developed for the natural languages by G. K. Zipf, when applied to these sequences, show significant promise. In particular, we argue, the Zipf's exponent differentiates, and hence, identifies disparate human sequences.

Effect of high arsenic content in drinking water on rat brain.

The permissible limit of arsenic content in drinking water is 0.05 ppm, whereas, in many parts of West Bengal the arsenic level in drinking water is 0.1 ppm, frequently 0.3 ppm and even 3.0 ppm, though rarely. In order to assess possible risk to brain function by drinking such water, rats were given arsenic mixed in drinking water at the above four concentrations for 40 days. There was increased lipid peroxidation at all doses of arsenic, including the 'permissible limit', decrease in glutathione level, superoxide dismutase and glutathione reductase activities, indicating the free-radical-mediated degeneration of brain.

Effect of isoproturon on male reproductive system: clinical, histological and histoenzyonological studies in rats.

Isoproturon, a nonhalogenated substituted phenylurea herbicide, was evaluated for its cumulative toxic effects on testicular histomorphology., steroid hormone biosynthesis-related enzymes, spermatogenesis and sperm cells in adult albino rats. The compound, suspended in refined groundnut oil, was administered (po) to rats for 10 weeks @ 0,200, 400 and 800 mg/kg/day for 6 days/week. Isoproturon, at 800 mg/kg dose, decreased epididymal sperm count and percentage of motile sperms and increased the percentage of morphologically abnormal sperm cells. At the same dose, diameter of seminiferous tubules was reduced, number of tubules per microscopic field was increased and the percentage of tubules with evidence of spermatogenesis decreased. However, the percentage of damaged tubules was increased with 400 and 800 mg/kg doses. Histoenzymological observations revealed dose-related reduction in the activities of glucose-6-phosphate dehydrogenase and delta 5-3 beta-hydroxy steroid dehydrogenase. Activity of 17 beta-hydroxy steroid dehydrogenase was not affected appreciably. Overall findings suggest that isoproturon, at high dose, impairs androgen biosynthetic process, affects spermatogenesis and induces maturational anomalies of sperm cells in rat.