Orogenital ulcers and the Behcet’s disease

Behcet’s’s disease is a systemic vasculitis involving small to large veins and arteries. It is a sporadic disease, mostly prevalent among the ancestors of the silk route. It is characterized by recurrent oral ulcers, genital ulcers, and uveitis. It also can manifest as skin, vascular, gastrointestinal, neurological, cardiac, and renal involvement. Though overall mortality is around 5%, delay in diagnosis and treatment may lead to significant morbidity. Cardiovascular and pulmonary arterial aneurysms are dreadful complications of this disease. Being uncommon in south India it is liable to be wrongly diagnosed and treated. Delay in the diagnosis and treatment may lead to severe complications. Here we present a case of Behcet’s disease which was managed at primary health care inadequately. We also demonstrated a quick response to steroids which are the mainstay of treatment. In this case presentation we illustrated pre and post treatment scrotal and oral Behcet’s’s lesions for clinicians to memorize. We also discussed international criteria to diagnose Behcet’s disease (ICBD) in concurrence with our case. In this presentation, we briefly described the involvement of other systems and their treatment. This article also elaborated on the latest developments in the treatment of Behcet’s disease.

Assessment of minimum inhibitory concentration to vancomycin, tigecycline, linezolid, daptomycin, ceftaroline and mupirocin against methicillin resistant Staphylococcus aureus clinical isolates by antibiotic gradient strips

Background: Staphylococcus aureus infections are one of the most common and serious hospital-acquired infections seen in developing countries. Methicillin resistant Staphylococcus aureus (MRSA) is an important human pathogen and normally colonized in body parts including skin, nose, perineum and throat. MRSA is resistant not only to all ?-lactam groups but also other antibiotics including aminoglycosides, tetracycline and macrolides. In the present study the efficacy of agents used in the management of MRSA infections was determined by antibiotic gradient testing. Methods: A total of 60 clinical isolates of MRSA strains were collected from various diagnostic labs in central Kerala. Clinical isolates were reconfirmed as MRSA by gram staining, yellow-coloured colonies on mannitol salt Agar (MSA). Antibiotic susceptibility testing was done by disc diffusion method as recommended by CLSI guidelines. S. aureus isolates resistant to cefoxitin (30 µg) was identified as MRSA. Antibiotic gradient testing was performed to determine the MIC of vancomycin, tigecycline, linezolid, daptomycin, ceftaroline and mupirocin against MRSA isolates. Results: All the 60 MRSA isolates tested were sensitive to vancomycin, tigecycline, linezolid, daptomycin, ceftaroline and mupirocin (100%) and none of the MRSA isolates show resistance. Conclusions: Results of present study indicates that these agents may be used alongside vancomycin in management of infection caused by MRSA.

Detection of colistin susceptibility in extended spectrum ? lactamases positive Klebsiella pneumoniae and Escherichia coli clinical isolates by broth disc elution method

Background: Antibiotic resistance is one of the greatest threats in human health. Extended spectrum ? lactamases mediated resistance is prevalent worldwide, Klebsiella pneumoniae and Escherichia coli leap out as this significant ESBL producers conferring resistance to the expanded spectrum cephalosporins. Colistin is being administered as last line therapy for patients that have failed to respond to other available antibiotics that are active against Gram-negative bacteria. Methods: The present study was conducted at school of medical education Kottayam, Kerala from January 2023 to November 2023.During the period of study 150 isolates of K. pneumoniae and 136 isolates of E. coli were collected from various diagnostic microbiology laboratories in Kerala. The colistin susceptibility pattern of ESBL producing isolates was detected by broth disc elution method recommended by CLSI. Results: In this study prevalence of multi-drug resistant is 6% and 9.6% and Extensively-drug resistant is 62% and 63.9% for K. pneumoniae and E. coli respectively. ESBL production was detected as 72% in K. pneumoniae and 79% in E. coli. The colistin susceptibility pattern of ESBL producing K. pneumoniae and E. coli was detected as 76.9% and 87.9% respectively Conclusions: Our result demonstrated that the recent use of colistin as last resort treatment for extensively drug resistant gram-negative bacilli, it is essential to know the prevalence of susceptibility pattern to this antibiotic.

Evaluation of antimicrobial activity of Lactobacillus acidophilus and Lactobacillus rhamnosus against clinically isolated Klebsiella pneumoniae: an in vitro study

Background: Klebsiella pneumoniae are Gram-negative opportunistic pathogen, belonging to the family Enterobacteriaceae that can cause severe nosocomial infections particularly in immuno-compromised individuals. They exhibit co-resistance to multiple antibiotics which emphasize the need for non-antibiotic therapies. The goal of the presented study was to investigate the antimicrobial ability of probiotic Lactobacilli on clinical isolates of K. pneumoniae. Methods: In this cross-sectional study, antimicrobial activities of probiotic L. acidophilus and L. rhamnosus on K. pneumoniae were evaluated by Agar overlay interference technique. Clear zone around Lactobacilli were taken as positive inhibition. Antibiotic susceptibility profiles of K. pneumoniae were determined by Kirby-Bauer disk diffusion method, analyzed using interpretive standards of CLSI M100-S33 and categorized into MDR, XDR and Non MDR groups. Statistical analysis was done using descriptive statistics such as mean and standard error and inferential statistics such as ANOVA single factor. Results: K. pneumoniae exhibited positive inhibition with both the probiotic strain. On comparing the zone of inhibition of L. acidophilus and L. rhamnosus (both treated-pH adjusted and untreated), L. acidophilus had greater zone of inhibition against K. pneumoniae but concluded that statistically the values are insignificant (p>0.05). Based on antibiotic susceptibility pattern of K. pneumoniae, 63% of isolates were XDR, 3% were MDR and 34% were Non MDR Conclusions: It can be concluded that L. acidophilus and L. rhamnosus had significant inhibitory effect against K. pneumoniae in vitro and should be further studied for their human health benefit.

Phospholipase, proteinase, esterase and haemolytic activity of Candida species isolated from oral cavity and its antifungal susceptibility pattern

Background: Candida species is a normal commensal flora of human body inhabiting the skin, mucous membrane and gastro intestinal tract but may be associated with superficial and deep-seated fungal infections. The switch of Candida species from commensal to a potent pathogen, is facilitated by various extracellular hydrolytic enzymes. The aim of this study was to estimate the phospholipase, proteinase, haemolysin and esterase activity of Candida species and to determine the antifungal susceptibility. Methods: Total 100 isolates of Candida spp. were collected from diagnostic microbiology laboratories in central Kerala. Phospholipase, proteinase, esterase and haemolytic activity was determined by early defined methods of Price et al, Aoki et al, Walter Rudek and Manns et al, respectively. Results: C. tropicalis exhibited highest phospholipase, proteinase and esterase activity followed by C. albicans and C. krusei. C.albicans shows highest haemolytic activity followed by C. tropicalis and C. krusei. Conclusions: Extracellular enzymes, phospholipase, proteinase, esterase and haemolysin was detected among Candida species in the present study.

Detection of polymyxin B resistance in Enterobacterales by broth disk elution method

Background: Antibiotic resistance being the critical issue faced by medical field, especially by Gram negative bacteria. It is a great threat in the case of both hospitals acquired and community acquired infections. They possess various mechanisms for their survival. The widespread resistance in Gram negative bacteria has necessitated evaluation of the use of older antimicrobials such as polymyxins. Polymyxins are disfavoured owing to their potential clinical toxicity, especially nephrotoxicity. Thus, they got abandoned in the sixties. But now they are re- emerged and used as last resort antibiotics. Methods: 274 isolates of Enterobacterales including Klebsiella pneumoniae, Escherichia coli, Citrobacter spp. Enterobacter spp. was collected from various diagnostic microbiology laboratories in Kerala. The polymyxin resistance among Enterobacterales by broth disk elution method recommended by CLSI. Results: In this study prevalence of multi drug resistant is 37% and extensively drug resistant strains is 25%. And the threatening fact is that the colistin also shows resistance among Enterobacterales (9.2%). Conclusions: Though the resistance to Polymyxin B is to the lesser side in the present study, increase in resistance to the agent is being documented globally elsewhere. So, rational use of Polymyxin B is warrantied as we could cherish polymyxin B as a 搇ife - saving drug� to avoid no drug available. Knowledge of antimicrobial resistance and development of new antimicrobial agents and improved treatments are essential in the current situation.

An in vitro study on comparative adherence of oral Candida albicans and non朼lbicans Candida to human buccal epithelial cells and its antifungal susceptibility pattern

Background: Candida spp. are intra-oral commensals in 40-60% of human subjects and the precise factors involved in the development of Candidiasis are still not clear. The adherence of Candida to epithelial cells is one of the main pathogenic characteristics of the genus. Studies have shown that there are variations in the adherence capabilities of different Candida spp., which may explain why some species colonize mucosal surfaces more frequently than others. The aim of this study was to estimate the adherence properties of Candida spp. to buccal epithelial cells and to determine the antifungal susceptibility. Methods: 87 isolates of Candida spp. from known non-diabetic patients with oral Candidiasis were collected from diagnostic microbiology laboratories in central Kerala. The method of Kimura and Pearsall et al was followed with minor modifications to test the adherence. Results: All the three species exhibited adherence with varying capacity. C. albicans was significantly more adherent to buccal epithelial cells than C. tropicalis and C. krusei. Resistance was not observed among the isolates against fluconazole, voriconazole and clotrimazole. Conclusions: In conclusion Candida spp. isolated from oral candidiasis patients exhibited a higher adherence capacity to normal human buccal epithelial cells considered an essential virulence property. As anticipated C. albicans displayed higher virulence activity than non-Candida albicans species.

An in vitro study of probiotic activity exhibited by Lactobacillus acidophilus and Lactobacillus rhamnosus on oral isolates of Streptococcus mutans and Candida albicans

Background: Oral infections caused by microorganisms have led to increased risk of oral health problems like dental caries (DC). Streptococcus mutans and Candida albicans are the organisms responsible for DC. The goal of the presented study was to investigate the potential of probiotics to prevent and treat DC. An in vitro assay was developed to investigate several probiotic strains for their ability to inhibit the aforementioned oral pathogens. Methods: 40 oral isolates of Streptococcus mutans and 51 oral isolates of Candida albicans were tested for probiotic activity against Lactobacillus acidophilus and Lactobacillus rhamnosus using agar overlay interference technique as prescribed by Fleming et al. Results: The zone of inhibition shown by L. acidophilus was higher than L. rhamnosus against Streptococcus mutans and Candida albicans. Conclusions: In conclusion the two probiotic strains L. acidophilus and L. rhamnosus exhibited inhibitory activity on S. mutans and C. albicans respectively in vitro.

An in vitro study of probiotic activity exhibited by Lactobacillus acidophilus and Lactobacillus rhamnosus on oral isolates of Streptococcus mutans and Candida albicans

Background: Oral infections caused by microorganisms have led to increased risk of oral health problems like dental caries (DC). Streptococcus mutans and Candida albicans are the organisms responsible for DC. The goal of the presented study was to investigate the potential of probiotics to prevent and treat DC. An in vitro assay was developed to investigate several probiotic strains for their ability to inhibit the aforementioned oral pathogens. Methods: 40 oral isolates of Streptococcus mutans and 51 oral isolates of Candida albicans were tested for probiotic activity against Lactobacillus acidophilus and Lactobacillus rhamnosus using agar overlay interference technique as prescribed by Fleming et al. Results: The zone of inhibition shown by L. acidophilus was higher than L. rhamnosus against Streptococcus mutans and Candida albicans. Conclusions: In conclusion the two probiotic strains L. acidophilus and L. rhamnosus exhibited inhibitory activity on S. mutans and C. albicans respectively in vitro.

Impact of Oral Metronomic Therapy on Quality of Life in Advanced/Recurrent Head and Neck Squamous Cell Carcinoma Patients

Introduction: Metronomic chemotherapy (MC) is an emerging therapeutic option in clinical oncology and it may prove usefulat least in metastatic head and neck squamous cell carcinoma (HNSCC) patients. To develop rational therapeutic strategies,it is important to identify molecular targets that are linked to the pathogenesis of HNSCC.Aim: The aim of the study was to assess the effect of oral MC on changes in quality of life (QOL) in advanced/recurrent HNSCCpatients.Materials and Methods: Patients with advanced, metastatic, and recurrent HNSCC patients who are not amenable to localtreatment with surgery, radiotherapy, and chemotherapy were included in the study. QOL assessed with the European organizationfor research and treatment of cancer (EORTC) QLQ-C30 and QLQ-H&N 35 questionnaires.Results: In this study, 50 patients were included, 37 patients (74%) become pain-free at the end of 6 months. A decreasedpain grade was observed in another 13 patients (26%). Mean QLQ-C 30 score at the time of presentation was 68.67, 75.35at 2 months, 81.26 at 4 months, and 85.38 at the end of 6 months. Mean QLQ-H&N 35 score at the time of presentation was61.53, 72.16 at 2 months, 76.43 at 4 months, and 81.69 at the end of 6 months. In subgroup analysis, both QLQ-C30 andQLQ-H&N 35 significantly correlated with disease progression.Conclusion: The use of oral metronomic therapy with methotrexate and celecoxib significantly improves the QOL and improvespain control in patients with advanced/recurrent HNSCC

A Study of Multi - Organ Involvement in Leptospirosis.

Background: Awareness about the infection is scarce especially in the developing countries as a consequence of which, it is rarely thought of in the differential diagnosis of febrile illnesses. Failure to diagnose leptospirosis is particularly unfortunate: severely ill patients often recover completely with prompt treatment but if therapy is delayed or not given, death or renal are likely to ensure. Methods: A total 50 patients who were admitted with fever at JSS hospital, medicine department over a period of 2 years that is during August 2005 to August 2007 who have been diagnosed to have leptospirosis fulfilling the inclusion and exclusion criteria. Present study design is a prospective study during which patient will be followed up during hospital stay, recovery and one month after discharge. Results: In our study out of 5 patients 16 patients (32%) had no complications, 34 patients (68%) have developed various complications. 4 patients (8%) developed ARF, 7 patients (14%) developed hepatitis, 17 patients (34%) ARF with Hepatitis, 2 patients (4%) Hepatitis with altered sensorium, 1 patient (2%) developed Myocarditis; Hepatitis; ARF, 1 patient (2%) developed ARF; ARDS; Hepatitis; Myocarditis, 2 patients (4%) ARDS with ARF and Hepatitis. Conclusion: Early diagnosis & initiation of treatment of leptospirosis prevents mortality and morbidity.

Apical stress distribution on maxillary central incisor during various orthodontic tooth movements by varying cemental and two different periodontal ligament thicknesses: A FEM study.

Context: During fixed orthodontic therapy, when the stress levels in the periodontal ligament (PDL) exceedsan optimum level, it could lead to root resorption. Aims: To determine an apical stress incident on the maxillary central incisor during tooth movement with varying cemental and periodontal ligament thickness by Finite Element Method (FEM) modeling. Settings and Design: A three dimensional finite element model of a maxillary central incisor along with enamel, dentin, cementum, PDL and alveolar bone was recreated using EZIDCOM and AUTOCAD software. ALTAIR Hyper mesh 7.0 version was used to create the Finite Element meshwork of the tooth. This virtual model was transferred to Finite Element Analysis software, ANSYS where different tooth movements were performed. Materials and Methods: Cemental thickness at the root apex was varied from 200 μm to 1000 μm in increments of 200 μm. PDL thickness was varied as 0.24 mm and 0.15 mm. Intrusive, Extrusive, Rotation and Tipping forces were delivered to determine an apical stress for each set of parameters. Results: Results indicated that an apical stress induced in the cementum and PDL, increased with an increase in cementum and PDL thickness respectively. Apical stress induced in the cementum remained the same or decreased with an increase in the PDL thickness. Apical stress induced in the PDL decreased with an increase in the cementum thickness. Conclusion: The study concluded that the clinical delivery of an orthodontic forces will cause stress in the cementum and PDL. Hence, it is necessary to limit the orthodontic force to prevent root resorption.

Effect of plant growth promoting rhizobacteria (PGPR) on growth and yield of bitter gourd.

A field study was conducted to determine the effect of plant growth promoting rhizobacteria (PGPR) on growth and yield of bitter gourd. Four PGPR strains (Azospirillum, Phosphorous solubilising bacteria, Pseudomonas flourescens and Bacillus subtilis), one commercial organic product (Aishwarya) and non inoculated control were used. The study revealed that seeds inoculated with Azospirillum (basal @ 5 kg ha-1 + 40 days after sowing (DAS) @ 5 kg ha-1) recorded early germination (6.48 days). The maximum vine length (4.42 m) was recorded in basal @ 2 l/plant application of both Bacillus subtilis and Pseudomonas flourescens @ 2.5 kg ha-1. Number of primary branches was maximum (4.80) in plants applied with phosphorous solubilising bacteria (PSB) as basal @ 5 kg/ha and 40 DAS @ 5 kg/ha. Tap root length (23.57 cm) and secondary root length (39.88 cm) were highest in the plants supplied with Azospirillum (basal @ 5 kg ha-1 + 40 DAS @ 5 kg ha-1) where as, dry root weight (4.64 g) was more in case of double application of Bacillus subtilis basal @ 2 l plant -1 + 40 DAS @ 2 l plant -1. Two time application of Bacillus subtilis basal + 40 DAS @ 2 l plant -1 produced the maximum yield plant -1 and yield plot -1 (2.72 kg and 16.33 kg respectively).

Clinical validation of a low-cost telemedicine equipment remote medical diagnostics kit at a tertiary care hospital.

BACKGROUND: The Remote Medical Diagnostics kit is an indigenous and low-cost technology that can measure and transmit via the internet 6 clinical parameters viz. Blood pressure (BP), pulse, temperature, oxygen saturation, 12-lead Electrocardiogram (ECG) and heart/breath sounds. Prior to commercial use, it needs clinical validation. METHODS: Fifty three patients (including 1 acute myocardial infarction) were evaluated for the above parameters using accepted standard methods and the Remote Medical Diagnostics kit. RESULTS: The intraclass correlation coefficient (ICC) for systolic BP (SBP), diastolic BP (DBP), saturation pulse, manual pulse and temperature was 0.927, 0.904, 0.989, 0.99 and 0.912 indicating a high degree of agreement between the two methods. For oxygen saturation, the ICC was 0.763 indicating a moderately high agreement. For heart sounds, the kappa coefficient (kappa) for inter-rater reliability was 0.48 (observed agreement of 96.1%). For breath sounds, the 'kappa' value was 0.48 indicating moderate agreement. For the breath sounds, the 'kappa' value was 0.38, indicating fair agreement (the observed agreement of 94.2%). For the ECG, the observed agreement was 94.4% by visual assessment. CONCLUSION: At the bedside, the Remote Medical Diagnostics kit was clinically validated for the above 6 parameters.

Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder

OBJECTIVE: We report on a series of female patients with transitional cell carcinoma of the bladder who underwent extraperitoneal retrograde radical cystectomy sparing the female reproductive organs with neobladder creation. MATERIALS AND METHODS: 14 female patients between the ages of 45 and 72 years who underwent gynecologic-tract sparing cystectomy (GTSC) with neobladder between 1997 and 2002 were retrospectively reviewed. Our surgical technique is also described. Radical cystectomy is accomplished by a retrograde method sparing the uterus, adnexa, vagina and distal urethra. An orthotopic neobladder was constructed using small bowel or sigmoid colon, brought extraperitoneally, and anastomosed to the distal urethra. RESULTS: Operating time ranged from 4.5 to six hours with a mean of 5.3 hours. Ten patients were able to void satisfactorily while four required self-catheterization for complete emptying of the bladder. Seven patients were continent day and night and another 7 reported varying degrees of daytime and nighttime incontinence. One patient died of metastases and another of pelvic recurrence. There were no urethral recurrences. Patient satisfaction with the procedure was high. CONCLUSIONS: Gynecologic-tract sparing cystectomy with orthotopic neobladder is a viable alternative in female patients with muscle invasive traditional cell carcinoma of the bladder, providing oncological safety with improved quality of life. Our extraperitoneal technique, which is an extension of our successful experience with retrograde extraperitoneal radical cystectomy in men, minimizes intraoperative complications and simplifies the management of post-operative morbidity with the neobladder.

Aspiration of a tracheostomy tube flange.

Foreign body aspiration is a common pediatric emergency. Aspiration of a metallic tracheostomy tube flange into the left main bronchus and the resultant subacute respiratory distress is presented. Being the only case of its kind in reported pediatric literature, a review of the etiology, clinical presentation and prevention of this accident is appended.

Isolation and evaluation of diagnostic value of two major secreted proteins of Mycobacterium tuberculosis.

Two secreted antigens of Mycobacterium tuberculosis, namely the antigen 85 complex (30/31) and 38kDa antigens, were purified from the whole culture filtrate by using two dimensional preparative electrophoresis and anion exchange chromatography, respectively. Individual components of the antigen 85 complex namely, antigen 85A, 85B and 85C, were separated using hydrophobic interaction chromatography. The humoral antibody activity to these antigens in sputum positive cases of active pulmonary tuberculosis and normal healthy volunteers was determined by enzyme linked immunosorbent assay (ELISA) and immunoblot. Recombinant 38kDa and antigen 6 were used as reference antigens for the assay. None of the healthy volunteers reacted with the 38kDa antigen, while 52% of the TB sera reacted with it. Of the three components of the antigen 85 complex, 85B gave the highest positivity of 40 per cent. The results of combination of 38kDa with antigen 6 offered better results with 76% positivity.

Translocation Down syndrome.

Cytogenetic investigations carried out on 1021 cases of Down syndrome revealed translocation in 46 cases. The most frequent was of t(14;21) and t(21;21) types. Most of the translocation DS cases (n = 31) were born to younger mothers (< 25 years), when compared to pure trisomy 21 DS cases. Parental karyotypes, family history and parental ages has helped us greatly in offering genetic counseling, prenatal diagnosis and estimating the risk for the next conception.

Translocation Down syndrome.

Cytogenetic investigations carried on 1021 cases of Down syndrome revealed translocation in 46 cases. The most frequent was of t(14;21) and t(21;21) types. Most of the translocation DS cases (n = 31) were born to younger mother's (< 25 years), when compared to pure trisomy 21 DS cases. Parental karyotypes, family history and parental ages has helped us greatly in offering genetic counseling, prenatal diagnosis and estimating the risk for the next conception.

Beta2-glycoprotein I dependent anticardiolipin antibodies and lupus anticoagulant in patients with recurrent pregnancy loss.

AIM: The present study was aimed to define the incidence of antiphospholipid antibodies of different types lupus anticoagulant (LAC), venereal disease research laboratory test (VDRL) and Beta2-glycoprotein I dependent anticardiolipin antibodies Beta2 I aCL) in our cohort of population experiencing recurrent pregnancy loss (RPL) from Andhra Pradesh, South India. SETTING AND DESIGN: A referral case-control study at a tertiary centre over a period of 5 years. PARTICIPANTS: 150 couples experiencing 3 or more recurrent pregnancy losses with similar number of matched controls. MATERIAL AND METHODS: LAC activity was measured by the activated partial thromboplastin time (aPTT) according to the method of Proctor and Rapaport with relevant modifications. VDRL analysis was performed by the kit method supplied by Ranbaxy Diagnostics Limited and Beta2 Glycoprotein I dependent anticardiolipin antibodies were estimated by ELISA kit (ORGen Tech, GmbH, Germany) with human Beta2 Glycoprotein I as co-factor. STATISTICAL ANALYSIS: Statistical analysis was performed using Student's t test. RESULTS: LAC activity was found positive in 11 women (10.28%). The mean +/- SE Beta2 I aCL concentration in the study group was 14.53 (micro/ml) +/- 1.79 (range 0 to 90.4 micro/ml) which was higher than the control group with a mean +/- SE of 7.26 (micro/ml) +/- 0.40 (range 0 to 18 u/ml). The binding of the antibodies to the antigen was observed in 40.24% (n=33) of the cases compared to 6.09% (n=5) in controls. VDRL test was positive in 7(2.34%) individuals (3 couples and 1 male partner) and none among controls. CONCLUSIONS: The present study indicates the importance of antiphospholipid antibodies in women experiencing RPL and suggests the usefulness of screening for these antibodies as a mandatory routine for instituting efficient therapeutic regimens for a successful outcome of pregnancy.