Receptor Activator of NF-kB Ligand Induced Osteoclastogenesis in Cervical Spondylosis - Role of Balamula Ghritam (A Powerful Antioxidant Drug) as Uttarabhaktika Sneha

The discs which are located in between the vertebras to act as shock absorbers during jolts to prevent spine injuries get either dislocated, bulged out or get thinned on continuous pressure being exerted upon them either by travel or a posture that is unsuitable to their alignment. In cases of discs getting thinned out and the height of these discs get reduced due to various causes produce undue pressure over the cervical spine resulting in oxidative stress and production of free radicals in the body causing deterioration of bone tissue and bone mass leading to regulation of RANKL/OPG ratio levels causing degeneration of bone. It is possible to resurrect the dehydrated discs with rehydration using Balamula (Sida cordifolia root) with the help of its properties and actions that it can positively act upon the area by refilling the gaps of erosions and assure a recovery with the proper administration of it in the form of ghee which has been processed with it and its intake being after food. Material & Methods: Various Ayurvedic classical textbooks and published journal articles were reviewed and analysed. Results: Evidences from various studies show that the phytochemicals obtain from Balamula (Sida cordifolia root) and Go- Ghritam (cow’s ghee) acts as antioxidant, reduces the activity of osteoclast and bone resorption by inhibiting RANKL receptor pathway. It also has anti-inflammatory, anti-arthritic, anti-analgesic effect that found to be effective in reducing the symptoms of cervical spondylosis.

Strategies for ending tuberculosis in the South-East Asian Region: A modelling approach

Background & objectives: To support recent political commitments to end tuberculosis (TB) in the World Health Organization South-East Asian Region (SEAR), there is a need to understand by what measures, and with what investment, these goals could be reached. These questions were addressed by using mathematical models of TB transmission by doing the analysis on a country-by-country basis in SEAR. Methods: A dynamical model of TB transmission was developed, in consultation with each of the 11 countries in the SEAR. Three intervention scenarios were examined: (i) strengthening basic TB services (including private sector engagement), (ii) accelerating TB case-finding and notification, and (iii) deployment of a prognostic biomarker test by 2025, to guide mass preventive therapy of latent TB infection. Each scenario was built on the preceding ones, in successive combination. Results: Comprehensive improvements in basic TB services by 2020, in combination with accelerated case-finding to increase TB detection by at least two-fold by 2020, could lead to a reduction in TB incidence rates in SEAR by 67.3 per cent [95% credible intervals (CrI) 65.3-69.8] and TB deaths by 80.9 per cent (95% CrI 77.9-84.7) in 2035, relative to 2015. These interventions alone would require an additional investment of at least US$ 25 billion. However, their combined effect is insufficient to reach the end TB targets of 80 per cent by 2030 and 90 per cent by 2035. Model projections show how additionally, deployment of a biomarker test by 2025 could end TB in the region by 2035. Targeting specific risk groups, such as slum dwellers, could mitigate the coverage needed in the general population, to end TB in the Region. Interpretation & conclusions: While the scale-up of currently available strategies may play an important role in averting TB cases and deaths in the Region, there will ultimately be a need for novel, mass preventive measures, to meet the end TB goals. Achieving these impacts will require a substantial escalation in funding for TB control in the Region.

Colistin-sparing approaches with newer antimicrobials to treat carbapenem-resistant organisms: Current evidence and future prospects

Antimicrobial resistance is on the rise across the globe. Increasing incidence of infections due to carbapenem resistance organisms is becoming difficult to treat, due to the limited availability of therapeutic agents. Very few agents such as colistin, fosfomycin, tigecycline and minocycline are widely used, despite its toxicity. However, with the availability of novel antimicrobials, beta-lactam/beta-lactamase inhibitor-based and non-beta-lactam-based agents could be of great relief. This review covers three important aspects which include (i) current management of carbapenem-resistant infections, (ii) determination of specific types of carbapenemases produced by multidrug-resistant and extensively drug-resistant Gram-negative pathogens and (iii) the currently available novel beta-lactam/beta-lactamase inhibitors and non-beta-lactam-based agents' laboratory findings, clinical outcome and implications.

++Diagnostic Usefulness of HOMA-β and HOMA-IR in Diabetes Mellitus –A Review

Homeostatic model of assessment (HOMA) is a statistical method for assessing pancreatic β – cell function (HOMA - β) andinsulin resistance (HOMA – IR). Both are calculated using fasting plasma glucose (FPG) and insulin but with differentformulae. A modified form of HOMA is emerging using Connective Peptide (C - Peptide) concentration, but studies based onthis have been very limited. More than 500 research papers have been published about the use of HOMA to assess DiabetesMellitus (DM) and Cardiovascular Disease (CVD), but the main area of its application is in the field of DM. HOMA – IRhas been diagnostically more useful in all types of DM and obesity, in assessing prediabetes and detecting DM in theelderly. It has also been found to be useful during the gestational period. HOMA indices have been widely used along withGlycosylated Hemoglobin (HbA1c), but good standardization is very important for better clinical use of HOMA. This reviewarticle has given condensed highlights on the clinical usefulness of HOMA in monitoring the control of DM at various stagesusing simple formulae to calculate HOMA indices. The parameters used were FPG and insulin. HOMA indices were alsocompared with other parameters such as HbA1c and two emerging parameters Obstatin and Visfatin, but very few studieshave been reported about their clinical usefulness. The contents of this review articles can be very useful for futureresearchers to expand the application of HOMA indices to the other diseases induced by the uncontrolled DM

Newer ?-Lactam/?-Lactamase inhibitor for multidrug-resistant gram-negative infections: Challenges, implications and surveillance strategy for India

Antimicrobial resistance (AMR) is a major public health concern across the globe, and it is increasing at an alarming rate. Multiple classes of antimicrobials have been used for the treatment of infectious diseases. Rise in the AMR limits its use and hence the prerequisite for the newer agents to combat drug resistance. Among the infections caused by Gram-negative organisms, beta-lactams are one of the most commonly used agents. However, the presence of diverse beta-lactamases hinders its use for therapy. To overcome these enzymes, beta-lactamase inhibitors are being discovered. The aim of this document is to address the burden of AMR in India and interventions to fight against this battle. This document addresses and summarises the following: The current scenario of AMR in India (antimicrobial susceptibility, resistance mechanisms and molecular epidemiology of common pathogens); contentious issues in the use of beta-lactam/beta-lactamase inhibitor as an carbapenem sparing agent; role of newer beta-lactam/beta-lactamase inhibitor agents with its appropriateness to Indian scenario and; the Indian Council of Medical Research interventions to combat drug resistance in terms of surveillance and infection control as a national response to AMR. This document evidences the need for improved national surveillance system and country-specific newer agents to fight against the AMR.

National ethical guidelines for biomedical & health research involving human participants, 2017: A commentary

The Indian Council of Medical Research (ICMR) has been at the forefront in setting up the ethical guidance for the conduct of biomedical and health research in India. The latest version of National Guidelines for Biomedical and Health Research Involving Human Participants, 2017 was planned in order to provide a more detailed guidance to the existing topics in view of emerging ethical concerns and to add a number of newer areas in which guidance was lacking. The scope of the guidelines has been expanded to include socio-behavioural research related to health and research involving biological material and datasets. The guidelines have 12 sections which cover a wide range of topics and areas of research. The first six sections are more generic, applying to all types of biomedical and health research, while the next six sections are more subject specific. The guidelines have been revised in consultation with a large number of experts and stakeholders and went through an exhaustive process stretching over a period of two years in its drafting, review, consultation and finalisation. This commentary seeks to explain the process and key components of the Guidelines.

Current Practice of Iron doses for Treatment of Iron Deficiency Anaemia - A Review

Although functional impairment begins with iron deficiency in the absence of anaemia, the development of anaemia heralds a homeostatic dysfunction that impairs daily activity. Iron deficiency anaemia is often the reason for poor physical performance, maternal and child morbidity and referral to a healthcare professional. (1) Women in their reproductive years, pregnant women and children are most vulnerable to develop iron deficiency anaemia (IDA) and will be the focus of this review.

Guidelines for iron supplementation for Prophylaxis of Anemia in a National Programme - A Review

Recent National Family Health Survey-4 data shows that anaemia continues to be a major public health problem in India. In India much of the anaemia is due to iron deficiency, and women and children are at the greatest risk of anaemia. TheMinistry of Health and Family Welfare took a policy decision, in 2013, to develop the National Iron+ Initiative (NIPI) to address the prevailing iron deficiency anaemia. This initiative covered pregnant and lactating women, children and adolescents. However, the guidelines do not match the current World Health Organization (WHO) guidelines for prevention of iron deficiency anaemia in these population groups. The background evidence for the WHO and NIPI is thus reviewed to come to a common consensus on the optimum recommendation of iron supplementation for the population, while taking into consideration the feasibility of the program, without burdening the groups with iron over-dose. However, from the present review, there is a need for increased number of trials in India that could qualify for a high grade of evidence to support the guidelines of NIPI.

Point of Care Haemoglobin Estimation

The prevalence of anemia in India is still unacceptably high at 53.1 % in non-pregnant women, 50.3% in pregnant women, 58.4% in children 6 months and 22.7% in adult men(1) and remains a major public health problem. For screening, tracking as well as monitoring the progress of anemia in both in primary and community health care for public health programs, hemoglobin needs to be estimated accurately.

Echinocandins: Their role in the management of Candida biofilms

The importance of antifungal agents and their clinical implications has received little attention in comparison to antibiotics, particularly in the health-care setting. However, apart from bacterial infections rising in hospitals, the incidences of fungal infections are growing with the development of resistance to conventional antifungal agents. Newer antifungal agents such as echinocandins (ECs) have been extensively studied over the past decade and are recognised as a superior treatment compared with prior antifungals as a first line of therapy in tertiary institutions. Caspofungin (CAS), micafungin (MICA) and anidulafungin (ANID) are the three most widely used EC antifungal agents. The treatment of biofilm-associated fungal infections affecting patients in tertiary health-care facilities has been identified as a challenge, particularly in Indian Intensive Care Unit (ICU) settings. With the rising number of critically ill patients requiring invasive devices such as central venous catheters for treatment, especially in ICUs, these devices serve as a potential source of nosocomial infections. Candida spp. colonisation is a major precursor of these infections and further complicates and prolongs treatment procedures, adding to increasing costs both for hospitals and the patient. Analysing studies involving the use of these agents can help in making critical decisions for antifungal therapy in the event of a fungal infection in the ICU. In addition, the development of resistance to antifungal agents is a crucial factor for assessing the appropriate antifungals that can be used for treatment. This review provides an overview of ANID in biofilms, along with CAS and MICA, in terms of clinical efficacy, resistance development and potency, primarily against Candida spp.

Intrapatient variability in plasma rifampicin & isoniazid in tuberculosis patients

Background & objectives: Large variability in anti-tuberculosis (TB) drug concentrations between patients is known to exist. However, limited information is available on intrapatient drug levels during the course of anti-TB treatment (ATT). This study was conducted to evaluate intrapatient variability in plasma rifampicin (RMP) and isoniazid (INH) concentrations during ATT at start of the treatment, at the end of intensive phase (IP) of ATT and at the end of ATT in adult TB patients being treated in the Revised National TB Control Programme (RNTCP). Methods: Adult TB patients (n=485), receiving thrice-weekly ATT in the RNTCP, were studied. Two-hour post-dosing concentrations of RMP and INH were determined at month 1, end of IP and end of ATT, after directly observed drug administration. Drug concentrations were estimated by high-performance liquid chromatography. Results: The median (inter-quartile range) RMP concentrations during the first month, at end of IP and end of ATT were 2.1 (0.4-5.0), 2.4 (0.6-5.5) and 2.2 (0.5-5.3) ?g/ml, respectively. The corresponding INH concentrations were 7.1 (4.2-9.9), 7.2 (3.9-10.9) and 6.7 (3.9-9.5) ?g/ml. None of the differences in drug concentrations obtained at different time points during ATT were significant. RMP and INH concentrations at different time points were significantly correlated. Age and body mass index caused significant variability in drug concentrations. Interpretation & conclusions: Plasma RMP and INH estimations in adult TB patients at two hours after drug administration remained unaltered during ATT. Clinicians can consider testing drug concentrations at any time point during ATT. These findings may assume significance in the context of therapeutic drug monitoring of anti-TB drug concentrations.

CCR2, MCP-1, SDF-1α & DC-sign gene polymorphisms in HIV-1 infected patients with & without tuberculosis.

Background & objectives: Variability in the clinical outcome of persons exposed to and infected with HIV-1 and tuberculosis (TB) is determined by multiple factors including host genetic variations. The aim of the present study was to find out whether chemokine, chemokine receptor and DC-SIGN gene polymorphisms were associated with susceptibility or resistance to HIV and HIV-TB in south India. Methods: CCR2 V64I (G/A), monocyte chemoattractant protein-1 (MCP-1) -2518 A/G, stromal cell derived factor-1α (SDF-1α) 3’UTR G/A and DC-SIGN gene polymorphisms were studied by polymerase chain reaction based methods in HIV-1 infected patients without TB (n=151), with pulmonary TB (PTB) (n=81) and extrapulmonary TB (n=31), 155 PTB patients without HIV and 206 healthy controls. Results: The genotype frequencies of CCR2 V64I, MCP-1 -2518 and DC-SIGN polymorphisms did not differ significantly between the study groups. A significantly increased frequency of GG genotype of SDF-1α polymorphism was observed among HIV+PTB+ patients compared to healthy controls (P=0.009, Pc=0.027). Interpretation & conclusions: Our data suggest that GG genotype of SDF-1α 3’UTR polymorphism may be associated with susceptibility to PTB in HIV-1 infected patients. A better understanding of genetic factors that are associated with TB could help target preventive strategies to those HIV patients likely to develop tuberculosis.

Miliary tuberculosis in human immunodeficiency virus infected patients not on antiretroviral therapy: clinical profile and response to shortcourse chemotherapy.

BACKGROUND: An increase in tuberculosis (TB) incidence has been associated with human immunodeficiency virus (HIV). AIMS: To describe the clinical characteristics and treatment outcome of patients with HIV and miliary TB treated with short-course intermittent chemotherapy in the absence of access to highly active antiretroviral therapy (HAART). SETTINGS AND DESIGN: Prospective study of HIV infected adults referred to a TB clinic between July 1999 and July 2004. MATERIALS AND METHODS: On diagnosis of miliary TB, patients were treated with a standard regimen of two months of isoniazid, rifampicin, ethambutol and pyrazinamide followed by four months of isoniazid and rifampicin (2EHRZ 3 /4RH 3 ) thrice weekly and followed up for 24 months. Patients were reviewed clinically every month and two sputa were collected. Chest radiographs and blood investigations were done at two months, end of treatment and every six months thereafter. RESULTS: Of 498 patients with HIV and tuberculosis, 31 (6%) were diagnosed as miliary tuberculosis. At diagnosis, sputum smear was positive for acid-fast bacilli (AFB) in 14 patients (45%) and Mycobacterium tuberculosis was isolated in 21 (68%). The mean CD4 cell count was 129 +/- 125 cells/mm3 . Twenty-five patients were declared cured at the end of treatment (81%) while one (3%) died and five (16%) failed. The recurrence rate was 19.4/100 person-years and the median survival was 17 months (95% CI 14 to 20). None of the patients received antiretroviral therapy. CONCLUSIONS: Miliary TB tends to occur among HIV infected patients with severe immunosuppression. Though the initial response to short-course chemotherapy was encouraging, a high recurrence rate and mortality was observed indicating poor prognosis in HIV.

Hepatitis B or hepatitis C co-infection in individuals infected with human immunodeficiency virus and effect of anti-tuberculosis drugs on liver function.

BACKGROUND: Tuberculosis (TB) and hepatitis are the two common co-infections in patients infected with human immunodeficiency virus (HIV). Anti-tuberculosis treatment (ATT) may have an effect on the liver enzymes in these co-infected HIV patients. AIMS: To determine the prevalence of Hepatitis B and C virus coinfection in HIV infected patients in Tamilnadu and assess effects of anti-tuberculosis drugs on their liver function. SETTINGS: HIV positive subjects referred to the Tuberculosis Research Centre, Chennai. MATERIALS AND METHODS: All HIV infected patients referred to the Tuberculosis Research centre, from March 2000 to May 2004, were screened for Hepatitis B surface antigen (HBsAg) & Hepatitis C virus (HCV) antibodies by enzyme linked immunoabsorbent assay (ELISA). HIV infection was confirmed using two rapid tests and one ELISA. Patients were given either short-course anti-tuberculosis treatment or preventive therapy for tuberculosis, depending on the presence or absence of active TB, if their baseline liver functions were within normal limits. None of these patients were on antiretroviral therapy during the study period. STATISTICAL ANALYSIS: Paired t-test was used to find the significance between baseline and end of treatment liver enzymes levels, while logistic regression was done for assessing various associations. RESULTS: Of the 951 HIV-infected patients, 61 patients (6.4%) were HBsAg positive, 20 (2.1%) had demonstrable anti HCV antibodies in their blood. Serial estimation of liver enzymes in 140 HIV patients (81 being co-infected with either HBV or HCV) showed that 95% did not develop any liver toxicity while they were on anti-tuberculosis treatment or prophylaxis. CONCLUSIONS: The prevalence of hepatitis B and C coinfection was fairly high in this largely heterosexually infected population supporting the use of more careful screening for these viruses in HIV positive persons in this region. Anti-tuberculosis therapy as well as TB preventive therapy can be safely employed in HIV and hepatitis coinfected patients, if baseline liver function tests are within normal limits.

Pacemaker endocarditis caused by Pseudomonas aeruginosa treated successfully.

Infective endocarditis (IE) is a rare but serious complication of permanent cardiac pacemaker placement. Endocarditis in the presence of prosthetic valves and pacemakers is usually due to staphylococci. We present a case of pacemaker endocarditis caused by Pseudomonas aeruginosa that was successfully treated with a combination of antimicrobial therapy and percutaneous removal of the colonized lead.

Nocardia bacteraemia in an HIV positive patient - A case report.

Nocardiosis has been recognized in recent times as an unusual opportunistic infection associated with HIV. Bacteraemia due to this pathogen is even rarer and only few cases have been reported in the literature. We report here a case of pulmonary nocardiosis with bacteraemia, which was initially diagnosed as pulmonary tuberculosis. A high index of suspicion is required to diagnose this infection as the clinical presentation and radiographic features mimic pulmonary tuberculosis.

Seroprevalence of human immunodeficiency virus (HIV) infection among tuberculosis patients in Tamil Nadu.

BACKGROUND & OBJECTIVES: The dual epidemic of HIV and tuberculosis is a cause for concern in those countries where these two infections are prevalent in epidemic proportions. We undertook a survey at two sites in North Arcot district of Tamil Nadu in 1992-1993, to know the seroprevalence of HIV infection among tuberculosis patients. The objective of this study was to re-examine the prevalence of HIV infection among tuberculosis patients in a repeat survey. METHODS: The study was undertaken in four centres: District Tuberculosis Centre (DTC), Vellore, Tuberculosis Sanatorium, Pennathur (Vellore), District TB Centre (DTC), Kancheepuram and the Government Thiruvotteswarar Tuberculosis Hospital (GTTH), Chennai in the northern part of Tamil Nadu during 1997-1998. A total of 2361 newly diagnosed TB patients were registered in this study. HIV serology after pre-test counseling was done along with sputum examination for acid-fast bacillus by smear and culture for mycobacteria for all patients. RESULTS: The overall HIV seroprevalence among TB patients was 4.7 per cent. The highest HIV seropositivity rate was found among patients aged 30-39 yr (10.6%). HIV seroprevalence showed a wide variation among the different centres ranging from 0.6. per cent in DTC, Kancheepuram to 9.4 per cent in Pennathur Sanatorium, Vellore. Sputum smear positivity was 88 per cent among the HIV-negative and 83 per cent among HIV-positive tuberculosis patients. INTERPRETATION & CONCLUSION: HIV infection is on the rise among TB patients in Tamil Nadu. Acid-fast smear microscopy is adequate for the diagnosis of pulmonary tuberculosis, and drug resistance among HIV positive patients is not a major problem at this point of time; hence antituberculosis regimens recommended by the Revised National Tuberculosis Control Program (RNTCP) can be used to treat HIV positive patients with tuberculosis.

A study on a dental morphological variation. Tubercle of Carabelli.

Tubercle of Carabelli is a dental morphologic trait found on the mesiopalatal surface of maxillary deciduous second molar and maxillary permanent first molar crowns. Tooth with Tubercle of Carabelli is susceptible to dental caries. Tubercle of Carabelli also interferes with banding techniques during fixed orthodontic therapy. The aim of this study is to determine the distribution of this dental morphologic variation with its forms of expressivity in the maxillary deciduous second molars and maxillary permanent first molars and also to determine the dichotomous nature of this trait. Study models of 648 subjects were evaluated for the presence of the trait and its expression. 67.5% of maxillary deciduous second molars and 52.77% of maxillary permanent first molars displayed the trait. There is predominance among females in the prevalence in the maxillary deciduous second molars. Mild and moderate forms expressed in maxillary deciduous second molars is mostly the same as that of maxillary permanent first molars.