Indian Spices Enhance the Activities of Antibiotics against Human Pathogens Synergistically.

Background: Bacterial pathogens are considered aspredominant cause of human diseases throughout theworld. Until recently, antibiotics were considered aspromising agents against most bacterial pathogens butrecent reports suggest that there is growing resistance tocommonly used antibiotics creating a global healthcareproblem. Aim and Objectives: To investigate thesynergistic antibacterial potential of three differentantibiotics including Vancomycin, Clindamycin andCefotaxime with three popular Indian spices namelyCinnamomum zeylanicum (Dalchini), Trachysparmumammi (Ova) and Syzygium aromaticum (Clove) againsthuman pathogens Staphylococcus aureus,Enterococcus faecalis, Escherichia coli and Klebsiellapneumoniae. Material and Methods: Fourier-transformInfrared (FTIR) spectroscopy analysis was performedto detect molecular changes occurring while synergisticexposure of antibiotics and spices on pathogenicmicrobes. The addition of spices extracts showedenhanced activity of antibiotics against the pathogenshowever degree of antibiosis was varied according tobacterial species. Inhibition Zones (IZ) ranged from 0.0-34 mm. The highest IZ of 34.33 mm was found againstS. aureus where a combination of Cefotaxime and C.zeylanicum were applied. The synergy of spice extractswith antibiotics revealed an increase in the bactericidalactivity of standard antibiotics against pathogens. FTIRspectral analysis showed that, microorganisms showingresistance to antibiotics (Vancomycin and Clindamycin), alters important functional groups of antibioticsmight be resulting in decreased antimicrobialperformance. FTIR spectra's revealed common bands inantibiotics and spices such as nitroamines, aromaticphosphorus, benzene, bromide, carboxylic group,aliphatic esters, sulphonamides, primary alcohols,aliphatic ether, acid anhydride conjugate ring withketone and azo compounds, aromatic ethers, sulphonilchloride, sulphoamide etc. Interestingly, there wasincreased antimicrobial response for synergism whendecreased concentration of antibiotics and increasedconcentration of spice extracts were used. Conclusion:This investigation suggests that, spice extract could beused independently and in combination to elevate theperformance of antibiotics which addresses the issue ofdrug resistance in human pathogens.

Comparison of nested-multiplex, Taqman & SYBR Green real-time PCR in diagnosis of amoebic liver abscess in a tertiary health care institute in India.

Background & objectives: Amoebiasis is a common parasitic infection caused by Entamoeba histolytica and amoebic liver abscess (ALA) is the most common extraintestinal manifestation of amoebiasis. The aim of this study was to standardise real-time PCR assays (Taqman and SYBR Green) to detect E. histolytica from liver abscess pus and stool samples and compare its results with nested-multiplex PCR. Methods: Liver abscess pus specimens were subjected to DNA extraction. The extracted DNA samples were subjected to amplification by nested-multiplex PCR, Taqman (18S rRNA) and SYBR Green real-time PCR (16S-like rRNA assays to detect E. histolytica/E. dispar/E. moshkovskii). The amplification products were further confirmed by DNA sequence analysis. Receiver operator characteristic (ROC) curve analysis was done for nested-multiplex and SYBR Green real-time PCR and the area under the curve was calculated for evaluating the accuracy of the tests to dignose ALA. Results: In all, 17, 19 and 25 liver abscess samples were positive for E. histolytica by nested-multiplex PCR, SYBR Green and Taqman real-time PCR assays, respectively. Significant differences in detection of E. histolytica were noted in the real-time PCR assays evaluated (P<0.0001). The nested-multiplex PCR, SYBR Green real-time PCR and Taqman real-time PCR evaluated showed a positivity rate of 34, 38 and 50 per cent, respectively. Based on ROC curve analysis (considering Taqman real-time PCR as the gold standard), it was observed that SYBR Green real-time PCR was better than conventional nested-multiplex PCR for the diagnosis of ALA. Interpretation & conclusions: Taqman real-time PCR targeting the 18S rRNA had the highest positivity rate evaluated in this study. Both nested multiplex and SYBR Green real-time PCR assays utilized were evaluated to give accurate results. Real-time PCR assays can be used as the gold standard in rapid and reliable diagnosis, and appropriate management of amoebiasis, replacing the conventional molecular methods.

Trends in cancer incidence in Chennai city (1982–2006) and statewide predictions of future burden in Tamil Nadu (2007–16).

Background. This paper investigates cancer trends in Chennai and predicts the future cancer burden in Chennai and Tamil Nadu state, India, using data on 89 357 incident cancers from the Chennai registry during 1982–2006, published incidence rates from the Dindigul Ambilikkai Cancer Registry during 2003–06 and population statistics during 1982–2016. Methods. Age-specific incidence rates were modelled as a function of age, period and birth cohort using the NORDPRED software to predict future cancer incidence rates and numbers of cancer cases for the period 2007–11 and 2012–16 in Chennai. Predictions for Tamil Nadu state were computed using a weighted average of the predicted incidence rates of the Chennai registry and current rates in Dindigul district. Results. In Chennai, the total cancer burden is predicted to increase by 32% by 2012–16 compared with 2002–06, with 19% due to changes in cancer risk and a further 13% due to the impact of demographic changes. The incidence of cervical cancer is projected to drop by 46% in 2015 compared with current levels, while a 100% increase in future thyroid cancer incidence is predicted. Among men, a 21% decline in the incidence of oesophageal cancer by 2016 contrasts with the 42% predicted increase in prostate cancer. The annual cancer burden predicted for 2012–16 is 6100 for Chennai, translating to 55 000 new cases per year statewide (in Tamil Nadu). Breast cancer would dislodge cervical cancer as the top-ranking cancer in the state, while lung, stomach and large bowel cancers would surpass cervical cancer in ranking in Chennai by 2016. Conclusion. In order to tackle the predicted increases in cancer burden in Tamil Nadu, concerted efforts are required to assess and plan the infrastructure for cancer control and care, and ensure sufficient allocation of resources.

Polymorphic variants of β1 adrenergic receptor gene (Ser49Gly & Arg389Gly) in healthy Tamilian volunteers.

Background & objectives: Several studies reported the polymorphisms of β1-adrenergic receptor gene in healthy volunteers and its influence on cardiovascular disorders. We investigated the genotype and allele frequencies of Ser49Gly and Arg389Gly polymorphism in healthy volunteers of South Indian Tamilian population vis-à-vis other major ethnic groups. Methods: The genetic variants were determined by using Taqman 5’ nuclease assay- real time PCR analysis in 533 normal healthy volunteers (18-60 yr; M=290; F=243). The allelic discrimination analysis was done by 7700 SDS software. Results: The estimated genotype and allele frequencies of Ser49Gly and Arg389Gly polymorphism were compared with other major populations. The frequencies of the variant alleles Gly49 and Gly389 were 15.1 and 25.8 per cent respectively. Interpretation & conclusions: Our study shows that interethnic variation exists in the polymorphisms of β1-adrenergic receptor gene and the results generated in this study might serve as a genetic marker for further studies in Tamilian (South India) population.

Gly460Trp polymorphism of the ADD1 gene and essential hypertension in an Indian population: A meta-analysis on hypertension risk.

BACKGROUND: Essential hypertension is a complex genetic trait. Genetic variant of alpha adducin (ADD1) gene have been implicated as a risk factor for hypertension. Given its clinical significance, we investigated the association between ADD1 Gly460Trp gene polymorphism and essential hypertension in an Indian population. Further, a meta-analysis was carried out to estimate the risk of hypertension. METHODS: In the current study, 432 hypertensive cases and 461 healthy controls were genotyped for the Gly460Trp ADD1 gene polymorphism. Genotyping was determined by real time PCR using Taqman assay. Multiple logistic regression analysis was used to detect the association between Gly460Trp polymorphism and hypertension. RESULTS: No significant association was found in the genotype and allele distribution of Gly460Trp polymorphism with hypertension in our study. A total of 15 case-control studies were included in the meta-analysis. There was no evidence of the association of Gly460Trp polymorphism with hypertension in general or in any of the sub group. CONCLUSIONS: We found that the Gly460Trp polymorphism is not a risk factor for essential hypertension in a south Indian Tamilian population. However, the role of ADD1 polymorphism may not be excluded by a negative association study. Further, large and rigorous case-control studies that investigate gene–gene–environment interactions may generate more conclusive claims about the molecular genetics of hypertension.

Laparotomy for post chemotherapy residue in ovarian germ cell tumors.

BACKGROUND: Primary conservative surgery and cisplatin-based chemotherapy have resulted in high cure rates in malignant ovarian germ cell tumors. A significant proportion of advanced tumors may have post-chemotherapy residue and it is important to distinguish necrosis or fibrosis without viable tumor from persistent viable tumor and teratoma. AIMS: To evaluate the role of laparotomy in assessing the nature of post-chemotherapy residue in ovarian germ cell tumors. MATERIALS AND METHODS: Eighty-three patients with malignant ovarian germ cell tumors seen at Cancer Institute, Chennai between 1992 and 2002 were studied. Sixty-eight patients completed combination chemotherapy with cisplatin regimes, of whom 35 had radiological residual masses. Twenty-nine out of these 35 patients underwent laparotomy to assess the nature of the residue. RESULTS: On laparotomy, three patients had viable tumor, seven immature teratoma, three mature teratoma and 16 only necrosis or fibrosis. None of our patients with dysgerminoma, embryonal carcinoma, absence of teratoma element in the primary tumor and radiological residue of < 5 cm had viable tumor whereas all patients with tumors containing teratoma component initially had residual tumor. Absence of viable disease was higher in patients who had normalization of serum markers by two cycles of chemotherapy. CONCLUSION: Our study suggests that patients with absence of teratoma element initially, radiological residue of< 5 cm and normalization of serum markers after two cycles of chemotherapy do not require surgery to assess the nature of post-chemotherapy residue. However, laparotomy should be performed in patients with tumors that initially contain teratoma element and in those with sluggish tumor marker response after two cycles of chemotherapy since they have a high chance of having viable post chemotherapy residue.

Neuroparalysis and ventilatory support in severe tetanus.

In severe form of tetanus, even with maximum dose of muscle relaxants, spasms and apnoeic spells may persist and that may be life-threatening. The aim of this study was to assess the effect of neuroparalysing the patients and then providing ventilatory support in bringing about their recovery. Forty-nine adult patients of severe tetanus (Ablett's grade IIIA--6 patients and Ablett's grade IIIB--43 patients) were studied during the period from April, 1993 to February, 1996. Mean period of onset ie, period from trismus to first spasm, in these patients was 24 hours. Patients were neuroparalysed with a bolus dose of 2-4 mg of pancuronium followed by a continuous infusion of 1-2 mg/hour and simultaneously supported with mechanical ventilation until spasms subsided. Fourteen patients (28.6%) survived and rest died. Mean duration of ventilatory support on survived patients was 14.4 days. The commonest complication encountered during ventilatory support was respiratory tract infection observed in 36 patients (73.5%). Commonest cause of death was autonomic imbalance encountered in 15 patients (30.6%). Treatment of choice in severe tetanus should be neuroparalytic ventilatory support. With use of new generation ventilators and better intensive care facility, death in severe tetanus is likely to be very less.

Lymphoplasmacytic lymphoma with IgA paraproteinemia mimicking Waldenstrom's Macroglobulinemia.

Central to the diagnosis of Waldenstrom's Macroglobulinemia is the demonstration of bone marrow infiltration by lymphoplasmacytic lymphoma with Ig M monoclonal gammopathy. We describe a patient who presented with a clinical and haematological picture, highly suggestive of Waldenstrom's Macroglobulinemia, but whose serum monoclonal immunoglobulin belonged to Ig A class. Ig A secreting lymphoplasmacytic lymphoma undoubtedly exist but are exceedingly uncommon and their relationship to Waldenstrom's Macroglobulinemia needs to be clarified.

Melioidosis--a report from Pondicherry, South India.

Melioidosis is an acute infectious disease caused by a safety-pin-shaped gram-negative bacteria called Burkholderia pseudomallei. Here, we report the first case of melioidosis in a middle aged male agricultural worker, from Pondicherry. The isolation of this organism from subcutaneous nodules on the extensor aspect of his limbs underlines the diversity of its clinical presentation. Difficulty in identifying the organism which mimics any other non-fementing gram-negative bacilli (NFGNB) on cursory examination, highlights the importance of identification of NFGNB in endemic areas for specific treatment and prevention.

Primary cell culture from fish gills and kidney using fish serum.

A novel, cost effective and time saving technique for primary cell culture from gills and kidney using fish serum has been developed. Single cell suspension of gills and kidney of Clarias gariepinus was obtained by trypsinization. Minimum essential medium supplemented with 10% fish serum in place of 10% foetal calf serum and 20% fish muscle extract, yielded confluent monolayer on 6th and 8th day in gill and kidney tissue respectively at 28 degrees C. Fish serum can be successfully used as media supplement for cultivation and maintenance of primary cell culture from fishes.

Human anthrax in India: urgent need for effective prevention.

Anthrax is a zoonotic illness caused by Bacillus anthracis. Sporadic cases continue to be reported from many parts of the world. From India, both sporadic cases and outbreaks are being reported regularly. The Union Territory of Pondicherry (a former French colony) lies on the coast of Bay of Bengal, where the incidence of anthrax is on the rise with 28 cases being detected in the year 1999 and 2000 alone. So far, about 34 human cases have been encountered in this region. Recently, an increase in the number of anthrax cases has been noted in veterinary and human practice in this area. Most cases have occurred in agricultural labourers who gave history of handling animal meat or skin of infected animals. The meningitic form of the disease has a very bad prognosis. Patients with this form of disease died despite treatment with high dose penicillin. The typical bacilli were seen in the CSF in all cases of anthrax meningitis and was diagnostic of the condition. The cutaneous form of illness had a benign course and responded favourably to penicillin treatment. Awareness among clinicians and mandatory reporting of cases to public health departments along with public education will help control morbidity and mortality due to anthrax. Effective immunization of animals is the other important control measure for anthrax.

Epidemiology of cancer of the cervix: global and national perspective.

Cancer of the uterine cervix is one of the leading causes of cancer death among women worldwide. The estimated new cancer cervix cases per year is 500,000 of which 79% occur in the developing countries. Cancer cervix occupies either the top rank or second among cancers in women in the developing countries, whereas in the affluent countries cancer cervix does not even find a place in the top 5 leading cancers in women. The truncated rate (TR) in the age group 35-64 years in Chennai, India, is even higher (99.1/100,000; 1982-95) than rate reported from Cali, Colombia (77.4/100,000, 1987-91). The cervical cancer burden in India alone is estimated as 100,000 in 2001 AD. The differential pattern of cervical cancer and the wide variation in incidence are possibly related to environmental differences. Aetiologic association and possible risk factors for cervical carcinoma have been extensively studied. The factors are: Sexual and reproductive factors, socio-economic factors (education and income), viruses e.g., herpes simplex virus (HSV), human papillomavirus (HPV), human immunodeficiency virus (HIV) in cervical carcinogenesis and other factors like smoking, diet, oral contraceptives, hormones, etc. The accumulated evidence suggests that cervical cancer is preventable and is highly suitable for primary prevention. Sexual hygiene, use of barrier contraceptives and ritual circumcision can undoubtedly reduce cervical cancer incidence. Education, cervical cancer screening of high risk groups and improvement in socio-economic status can reduce cervical cancer morbidity and mortality significantly.

Behaviour change in HIV infected subjects following health education.

A total of 85 HIV seropositive subjects among consecutive new registrants in the STD Department were given health education measures directed to avoiding high risk behaviours and also the events with a high potential for transmission of infection. The emphasis was on the use of condoms, discontinuing promiscuity, abstaining from homosexual acts and avoidance of pregnancy and advice against marriage for those contemplating it. The Health Education Programme was delivered individually to each subject over two or three sessions, each lasting for 30 to 45 min. At the time of follow up (one to 24 months) 42 per cent of subjects had become non-promiscuous. There was a good compliance on advice against marriage and pregnancy. Seven infants born during the follow up period were seronegative. The use of condom was not found to be acceptable. The prostitutes comprised the most resistant group to education. Among the factors that influenced the behaviour change favourably was the absence of earlier STD or a short duration of the current STD. Literacy, marital status, awareness of AIDS did not influence the outcome of education. The study demonstrated the feasibility of health education at individual level in the clinical setting of an STD Department. A longer follow-up may indicate the sustainability of behaviour change in the subjects.

A comparative study of creatinine clearance rate in type I (IDDM) and II (NIDDM) diabetic patients.

The endogenous creatinine clearance test was done in 14 Type I and 15 Type II poorly controlled diabetic patients and compared with respective age matched healthy volunteers. Type I diabetics had significantly lower creatinine clearance rate, body mass index and serum albumin levels when compared to their control group. In Type II diabetics these values remained unaltered. Both Type I and Type II diabetics had significantly higher blood sugar and glycosylated haemoglobin levels. The creatinine clearance rate had significant positive correlation with patients' body mass index and serum albumin levels. This suggests that the undernutrition of Type I diabetics may be responsible for the decreased creatinine clearance.