Comparing Botulinum Toxin Versus Lord’s Procedure in Patients with Chronic Anal Fissure: A Prospective Study

Introduction: Anal fissure (AF) is a common disease. It causes considerable discomfort, loss of working days, and reduction in quality of life. Symptoms of AF include anal pain during defecation and bleeding per anus. Acute AF is treated conservatively, but chronic AF (CAF) does not usually respond to conservative treatment. Anal stretch (Lord’s procedure), reintroduced into AF therapy in 1964 with significant success rates, is, however, associated with recurrence rates varying from 2% to 80%, a high risk of incontinence (up to 51%), and is widely criticized despite a reported cure rate of approximately 90%. Materials and Methods: The present prospective study was conducted after due approval of “Scientific and Ethical Committee” in the Department of General Surgery of Mata Chanan Devi Hospital, New Delhi, during the period from October 2013 to May 2015 on patients attending the outpatient department or emergency department of this hospital. Results: In the present study, all 50 patients were selected and randomized into two treatment groups. Results were compared among two groups: Group B: Patients receiving Botulinum toxin-A (BOTOX) injection (n1 = 25) and Study Groups Group1=Group-B ,Group-2=Group-D. Randomisation Will Be As Follows. Group-B (Botox) Vs Group-D(Lords Procedure): Patients who underwent Lord’s procedure (n2 = 25). All results are well tabulated and described in figure format for well understanding in main article. Conclusion: BOTOX is as good as an option, compared to ancient yet routinely practiced LORD’S anal dilatation technique for CAF. BOTOX significantly reduces pain in patients with CAF as compared to Lord’s procedure. BOTOX has definite action in reducing the spasm of internal anal sphincter which is the chief cause of development of CAF. Spasm significantly improves with BOTOX compared to Lord’s procedure.

Production, purification and kinetics of chitinase of Stenotrophomonas maltophilia isolated from rhizospheric soil

Chitinases, through decomposition of chitin, have wide applications, and hence are in demand. Researchers over the period, are looking for potential microbial sources and for optimal production of chitnases. Here, we report isolation of three chitinolytic bacterial species belonging to three genera from different agricultural soil sample collected from Shahada, Maharashtra, India, on minimal agar plates containing colloidal chitin as source of chitin. Stenotrophomonas was found to be the most dominant species, followed by Pseudomonas and Alcaligenes. Stenotrophomonas maltophilia identified using 16s rRNA sequencing, Biolog and GC-FAME analysis showed optimum (1.5 U/mL) chitinase activity on chitin agar plates and in submerged culture broth with pH 6-7, incubation of 2 days at 37°C. Presence of CaCl2 stimulated the enzyme production but EDTA was suppressive. The enzyme upon purification by using sephadex G-100 gel filtration showed improved chitinolytic activity, enzyme kinetics and 2.4 fold increase in purification yield. The molecular weight of purified chitinase as determined by SDS-PAGE was 50-55 kDa.

Limnology and cyanobacterial diversity of high altitude lakes of Lahaul-Spiti in Himachal Pradesh, India.

Limnological data of four high altitude lakes from the cold desert region of Himachal Pradesh, India, has been correlated with cyanobacterial diversity. Physico-chemical characteristics and nutrient contents of the studied lakes revealed that Sissu Lake is mesotrophic while Chandra Tal, Suraj Tal and Deepak Tal are ultra-oligotrophic. Based on morphology and 16S rRNA gene sequence, a total of 20 cyanobacterial species belonging to 11 genera were identified. Canonical correspondence analysis distinguished three groups of species with respect to their occurrence and nutrient/physical environment demand. The first group, which included Nostoc linckia, N. punctiforme, Nodularia sphaerocarpa, Geitlerinema acutissimum, Limnothrix redekii, Planktothrix agardhii and Plank. clathrata, was characteristic of water with high nutrient content and high temperature. The second group, including Gloeocapsopsis pleurocapsoides, Leptolyngbya antarctica, L. frigida, Pseudanabaena frigida and N. spongiaeforme, occurred in oligotrophic water with high pH and low temperature. The distribution of third group of Cyanobium parvum, Synechocystis pevalekii, L. benthonica, L. foveolarum, L. lurida, L. valderiana, Phormidium autumnale and P. chalybeum could not be associated with a particular environmental condition because of their presence in all sampling sites. [Singh Y, Khattar JIS

Edward’s syndrome with a novel karyotype.

Edward’s syndrome was first described as a clinical entity in 1960 as a disorder of trisomy 18 (47 XX/XY; + 18) in babies with particular pattern of malformations. The Karyotype found in our case was (47 XX + 18 add (22) (p13) which has not been published so far in the literature. The less common findings noted in the baby were rocker bottom feet, syndactyly of 2nd and 3rd toes, microcephaly and corneal opacities. Though we didn’t find any significant association between phenotypic ranges with genotypic variation in literature, but further research is needed for it. We are reporting this case as the genotype is found to be novel.

Pulmonary fungal ball in non-immunocompromised patient: a case report.

Fungal ball caused by Aspergillus species is an opportunistic infection. We describe a case report of a patient with culture positive Aspergillus fumigatus who presented with complaints of cough and expectoration with recurrent episodes of haemoptysis. Tuberculosis is the commonest cause of haemoptysis in India. However fungal ball is also one of the leading cause of haemoptysis. Hence laboratory evaluation of haemoptysis should not only include work up for tuberculosis but sample should also be submitted for mycological evaluation.

Acanthamoebae presenting as primary meningoencephalitis in AIDS.

A rare case of Acanthamoebae meningoencephalitis is diagnosed in cerebrospinal fluid (CSF) of a 24 years old male suffering from acquired immunodeficiency syndrome (AIDS) patient on the basis of bright field microscopy and culture growth on non-nutrient agar with Escherichia coli. This case illustrates that Acanthamoebae should be considered in the differential diagnosis of meningoencephalitis in AIDS in addition to tuberculosis and cryptococcus infection in tropical areas.

Neutropenic enterocolitis.

We report a case of neutropenic enterocolitis diagnosed on computerized tomography abdomen in a 56-year-old man having high-grade non-Hodgkin's lymphoma. After appropriate management, the patient recovered completely.

Prevalence of methicillin resistant staphylococcus aureus in a tertiary referral hospital in eastern Uttar Pradesh.

We report the prevalence of methicillin resistant Staphylococcus aureus (MRSA) infections and their antibiotic susceptibility pattern in our hospital located in eastern Uttar Pradesh. Out of total 549 strains of Staphylococcus aureus isolated from different clinical specimens 301 (54.85%) were found to be methicillin resistant. More than 80% of MRSA were found to be resistant to penicillin, cotrimoxazole, ciprofloxacin, gentamicin, erythromycin, tetracycline, 60.5% to amikacin and 47.5% to netilmicin. However, no strains were resistant to vancomycin. Many MRSA strains (32.0%) were multi-drug resistant. To reduce the prevalence of MRSA, the regular surveillance of hospital associated infection, monitoring of antibiotic sensitivity pattern and formulation of definite antibiotic policy may be helpful.

The Escherichia coli antiterminator protein BglG stabilizes the 5'region of the bgl mRNA.

The beta-glucoside utilization (bgl) genes of Escherichia coli are positively regulated by the product of the bglG gene, which functions as an antiterminator by binding to specific sequences present within the bgl mRNA. BglG is inactivated by phosphorylation in the absence of beta-glucosides by BglF, the bgl-specific component of the phosphotransferase system (PTS). Here, we present evidence for an additional function for BglG, namely the stabilization of the 5' end of the bgl mRNA. Half-life measurements of the promoter-proximal region of the bgl mRNA indicate a five fold enhancement of stability in the presence of active (unphosphorylated) BglG. This enhancement is lost when the binding of BglG to mRNA is prevented by deletion of the binding site. Interestingly, stabilization by BglG does not extend to downstream sequences. The enhanced stability of the upstream sequences suggest that BglG remains bound to its target on the mRNA even after the downstream sequences have been degraded. Implications of these observations for the mechanism of positive regulation of the operon by BglG are discussed.

Prevalence of HIV among low and high risk population of eastern part of northern India.

A total of 7,904 persons visiting University Hospital of Banaras Hindu University (BHU), Varanasi, were screened for HIV antibody by ELISA and/or rapid test. The overall seroprevalence of HIV (3.17%) in this area was higher than that of Uttar Pradesh and India as a whole. The seroprevalence of HIV/AIDS among the high risk group (HRG) (6.42%) being significantly higher than low risk group (LRG) (0.37%). In the LRG, the prevalence among medical and surgical patients; and ANC (antenatal cases) was 1.17% and 0.14%, respectively. However, HIV infection was not detected in HCWs (healthcare workers), BHU students and foreigners. Among HRG, CSWs (commercial sex workers) had the highest prevalence (14.0%) and STD (sexually transmitted diseases) patients, the lowest prevalence (1.99%). The STD patients had significantly lower prevalence rate as compared to others in HRG. Majority of the HIV positive were found to be within the age group 15-44 years, with heterosexual mode as the main route of transmission. Seven HIV positive children were of 2-5 yr old age group. Majority of seropositive women (62.52%) were working in a low income jobs and were mainly infected by their spouses who was mostly migrating labourers of lower socioeconomic group and with less than primary level of education. Married females, being mainly the spouses of HIV positive males had the highest seropositivity (60.25%). These population people were directly transmitting the infection from the metropolitan cities to the rural areas of this region. Prevalence of HIV-2 was negligible as compared to HIV-1, the actual reason is yet to be explored.

Prevalence of human immunodeficiency virus infection in and around Varanasi, Uttar Pradesh, India.

Human Immunodeficiency Virus (HIV) infection is rising rapidly in the eastern Uttar Pradesh; however no data is available regarding its positivity rate. We have screened 1239 cases of various groups. HIV seropositivity rate of 0.28% was noted. These results suggest that HIV infection is spreading rapidly in this part of the country. M. tuberculosis was the commonest co-infection amongst them (29.5%). We recommend routine HIV screening of all patients of tuberculosis, especially if the persons frequent the cities, visit foreign countries where sex tourism is encouraged or stay away from their spouses for long periods as true history of sexual contact with commercial sex workers was difficult to obtain from them.

Herpes simplex virus-1 encephalitis in eastern Uttar Pradesh.

OBJECTIVE: To study the proportion of HSV-1 encephalitis in acute viral encephalitis. METHODS: One hundred and five patients presenting with clinical diagnosis of acute viral encephalitis and with exclusion of other possible causes of acute inflammatory brain disease prevalent in the area by relevant laboratory investigations were included in the study. Ninety single CSF samples were tested for HSV-1 IgM antibodies by ELISA test supplied by Dia Medix Corporation, USA. CT Scan and EEG studies were carried out in 25 patients. RESULTS: Clinical and neuro investigational profile of patients suggested a low incidence of HSV-1 encephalitis in the study group. IgM antibodies were present in CSF sample of one patient only. CONCLUSION: HSV-1 encephalitis constitutes a very low proportion (1.1%) of acute viral encephalitis cases seen in Eastern Uttar Pradesh (India).

AgNORs in endometrial lesions.

Silver nucleolar organizer region (AgNOR) staining was employed in one hundred specimens of endometrium. These included fifteen normal controls (Proliferative + Secretory endometrium) and eighty five lesions. Endometrial lesions comprised of endometritis (15), endometrial hyperplasia (25) and endometrial carcinoma (45). Three micron thick sections of paraffin embedded tissue were subjected to AgNOR staining as described by Crocker and Smith with a little modification of 0.01% safranin counterstain--The mean AgNOR scores were found to increase steadily from normal to endometritis to endometrial hyperplasia and carcinoma--The observations revealed statistically significant differences in values between atypical hyperplasia and carcinoma also. AgNOR staining and scoring is simple, inexpensive and a useful adjunct to routine histopathology to evaluate endometrial lesions especially to differentiate borderline lesions. Though scores cannot be standardized and fixed for a particular lesion as there are intralaboratory variations.

HIV infection in Varanasi.

A total of 6038 serum samples collected from individuals staying/residing in the eastern part of northern India, were screened for antibodies against HIV. The screening was done by ELISA and followed by confirmation of reactive samples by Western Blot. The seropositivity was detected in 154 (2.6%) persons. The prevalence amongst high risk groups was 68/1000 while it was 2.8/1000 in low risk population. The male to female ratio was 1.8:1 in seropositives. Increase by more than three folds in the prevalence was observed from 1994 (1.5%) to 1997 (5.0%). About 50% of the seropositives were in their third decade of life. Seropositives were predominantly (> 90%) from eastern Uttar Pradesh. Almost all the cases could be linked to Mumbai, one of the largest commercial and industrial centres of India.

Chlamydial serology and laparoscopic findings in infertile women.

Fifty-seven infertile women were studied for presence of chlamydial infection by detecting antichlamydial antibodies using indirect immunoperoxidase assay technique. Laparoscopy was performed in all of them. Inflammatory changes in fallopian tubes were present irrespective of serological status. Thus no rigid criteria for carrying out laparoscopy can be made. A high index of suspicion is required for detection of chlamydial infection as it runs an indolent course with no specific symptoms.

Inter-relationship between dental, skeletal and chronological ages in well-nourished and mal-nourished children.

Dental casts, wrist roentgenograms and full mouth radiographs of teeth of 80 mal-nourished and 40 well-nourished children were evaluated and compared for correlation of dental, skeletal and chronological ages. The findings revealed (1) very high correlation between dental and skeletal ages (r = 0.9584); (2) high correlation of chronological age with dental and skeletal ages (r = 0.8635 and r = 0.8716); (3) out of all the three correlations considered, dental and skeletal ages had the maximum correlation; (4) malnutrition had a significant adverse effect on the skeletal and dental ages. Greater the severity of malnutrition, more pronounced was its effect on the dental and skeletal ages; and (5) no evidence of severity of malocclusion with retarded skeletal and dental ages.

Non-specific vaginitis vis-a-vis Gardnerella vaginalis.

One hundred patients of vaginitis along with 50 age matched control women were studied. Non-specific vaginitis (NSV) was diagnosed on the basis of the presence of at least any three of the four parameters which included presence of thin gray homogeneous discharge, pH of the discharge greater than or equal to 4.5, liberation of fishy odour from the discharge after adding 10 per cent KOH and presence of clue cells Using these criteria, NSV was diagnosed in 22 of the 100 patients and in 4 of 50 control women. Gardnerella vaginalis was cultured from 23 of the 26 women with NSV and 19 women without NSV (8 patients and 11 normal women). Women with NSV showed statistically significant difference in the presence of clue cells, amine test positivity and concentration of G. vaginalis as compared to women without NSV.