Analysis of antimicrobial susceptibility pattern of ocular infections at Regional Ophthalmic Institute in India

Background: Ocular infections are a result of alteration in the normal microbial flora of eye. They are not only responsible for increase in morbidity varying from self-limiting trivial infection to sight threatening infection but also blindness.Methods: Patients with ocular infections were recruited at Regional Institute of Ophthalmology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh. Bacterial profile in ocular infections and susceptibility pattern to commonly used antibiotics were analyzed amongst these patients. The isolated organism was then identified by colony morphology, gram stain and biochemical test following which in vitro susceptibility test was performed by Kirby-Bauer disc diffusion method and interpreted clinically.Results: Staphylococcus aureus and coagulase negative Streptococcus were most common etiological agents of ocular infections in the present study. It was observed that bacterial isolates were highly (in 100% of cases) susceptible to vancomycin and chloramphenicol among gram positive organisms. Gram negative organisms showed higher susceptibility to moxifloxacin, tobramycin and gentamycin. Pseudomonas was seen to have sensitivity towards ceftazidime and cefazolin.Conclusions: The present study gives an insight into use of ocular antimicrobials in northern India. These findings illustrate the need for constant bacterial surveillance before starting empirical treatment.

Health and wellness centers: a paradigm shift in health care system of India?

An ambitious attempt to achieve the goal of universal ‘comprehensive’ primary care through health and wellness centres under the Ayushmann Bharat Scheme (ABS) has been made by the Ministry of Health and Family Welfare, Government of India. The scheme has widened the package of services available to beneficiaries and it also envisages continuum of care. However, there are pre-existing weaknesses in the three tired public health system in India which may threaten the success of this scheme. In this article we describe and analyze the newer services or initiatives at the health and wellness centres under the ABS. We also attempt to identify the Strengths, weaknesses, threats and opportunities associated with this initiative.

A prospective study to compare the efficacy of tacrolimus vs cyclosporine in vernal keratoconjunctivitis in children in India

Background: Vernal keratoconjunctivitis (VKC) is a chronic allergic conjunctival disease. Immunomodulatory drugs like cyclosporine is being used for its treatment. Tacrolimus is another immunomodulator drug that can be used in VKC. This study was done to compare the efficacy of tacrolimus and cyclosporine in VKC.Methods: This prospective study was conducted on 60 patients of either sex by dividing them into two groups. The first group was treated with cyclosporine (0.05%) ophthalmic eye drop and second group with tacrolimus (0.03%) ophthalmic ointment. Total five objective signs (hyperaemia, oedema, papillae, corneal involvement and tantra’s dot) and five subjective symptoms (itching, tearing, foreign body sensation, discharge and photophobia) data was collected and tabulated for statistical analysis.Results: Authors found TSSS in both groups decrease significantly (p <0.05 or p <0.01 or p <0.001) at all post periods as compared to respective predecessor periods except 4 weeks to 6 weeks in cyclosporine group and 6 weeks to 8 weeks in tacrolimus group. Similarly, for each period, on comparing the mean TSSS between the groups TSSS between the groups at all periods does not differed statistically though at final evaluation (mean change from baseline to 8 weeks), it improved 5.2% more in tacrolimus group (83.7%) than cyclosporine group (78.5%). Similarly, TOSS also decreased at all post periods except 4 weeks to 6 weeks, and 6 weeks to 8 weeks in cyclosporine group and 6 weeks to 8 weeks in tacrolimus group. Improvement in scores was 11.6% more in tacrolimus (81.6%) than cyclosporine (70.0%). Cyclosporine eye drops are associated with burning sensation and redness of eyes while transient ocular irritation was only observed side effect with tacrolimus.Conclusions: The study found tacrolimus is clinically better drug for treatment of vernal keratoconjunctivitis than cyclosporine and is also cost effective.

Comparative analysis of efficacy and adverse effects of tacrolimus vs cyclosporine in chronic dry eye disease: a tertiary care hospital based study

Background: Dry eye disease (DED) is the very common and underdiagnosed ocular condition affecting vision, quality of life, and the outcomes of cataract or refractive surgery. Dry eye disease (DED), either alone or in combination with other conditions, is a frequent cause of ocular irritation that leads the patients to seek ophthalmic care. Due to a wide variety of presenting symptoms, it is often unrecognized and this causes great frustration of the patient and treating physician. While these symptoms often improve with appropriate treatment, usually in majority of the cases the disease may not be curable. Aim of the study was to compare the efficacy of tacrolimus and cyclosporine in dry eye disease.Methods: This was a single centred, 3 months prospective study. Patients with unilateral or bilateral dry eye disease and an ocular surface disease index score >12, atleast one eye with schirmer score <5mm and TBUT <10 s were enrolled in the study. The enrolled patients were randomly divided into two groups, twenty-five patients in Group 1 and twenty three patients in Group 2 completed the follow up. Group 1(n =25) who received 0.03% tacrolimus eye ointment twice daily for consecutive 3 months and Group 2 (n= 23) received 0.05% cyclosporine eye drops twice daily for consecutive 3 months the primary efficacy outcome was Schirmer score after 3 months. The secondary outcomes were TBUT and adverse effects.Results: After 3 months, both the treatment groups showed significant improvement in mean Schirmer score (p<0.001) and mean TBUT (p <0.0001). However, on comparing both the groups, mean Schirmer score and mean TBUT, results were comparable. No patient discontinued treatment because of minor ocular adverse effects.Conclusions: Dry eye patients demonstrated improvement in Schirmer score and TBUT after 3 months of treatment with tacrolimus 0.03% ointment and cyclosporine 0.05% eye drops.

Sensitivity of last larval stadium of Chrysomya megacephala (Fabricius) to anti-allatin ageratochromene Precocene II.

Treatment of early and late third instar larvae of economically important insect C. megacephala with the ageratochromene precocene II resulted into precocious metamorphosis. The other effects included mortality, production of pupal-adult mosaics, reduction in percentage of adult emergence and formation of non-viable deformed adults that died after a few hours of emergence. The application of precocene II adversely hampered the normal growth, development and metamorphosis of the insect and the results show that precocene II has vast potential for excellent control of this insect of medico-veterinary importance and can be used in insect pest management programs.

Secretion of an alkaline protease from a salt- tolerant and alkaliphilic, Streptomyces clavuligerus strain Mit-1

An alkaliphilic and salt- tolerant actinomycete, Streptomyces clavuligerus strain Mit-1, was isolated from Mithapur, the western coast of India. The organism was Gram-positive, having filamentous, long thread like structure. The sporulation started after two days of growth and the optimum level of alkaline protease (130 U/ml) was produced during the early stationary phase. The strain could grow and produce protease with 0-10 percent NaCl (w/v), the optimum being 5 percent NaCl (w/v). Growth and protease production was optimum at pH 9 with substantial decline at neutral pH. Sucrose and gelatin were the best carbon and nitrogen sources respectively, whereas gelatin broth was the preferred medium for protease production. Mit-1 produced substantial protease with various amino acids, when employed as the sole nitrogen sources. Crude substrates, such as molasses, whey and wheat flour had significant effect on enzyme production. The results are quite valuable, as only few actinomycetes, particularly salt-tolerant alkaliphilic ones, have so far been explored for their enzymatic potential and process optimization.

Uma cepa halotolerante e alcalifílica de Streptomyces clavuligerus, Mit-1, foi isolada em Mithapur, na costa oeste da Índia. Esse microrganismo é Gram positivo e apresenta estrutura filamentosa na forma de longas cordas. A esporulação iniciou após dois dias de cultivo e o nível ótimo de produção de protease alcalina (130 U/ml) foi atingido no início da fase estacionária de crescimento. A cepa foi capaz de multiplicar com 0-10 por cento NaCl (w/v), com um ótimo de 5 por cento NaCl (w/v). O ótimo de crescimento e produção de protease foi atingido em pH 9, apresentando declínio substancial em pH neutro. Sacarose e gelatina foram as melhores fones de carbono e nitrogênio, respectivamente, enquanto o caldo gelatina foi o melhor meio para produção de protease. A cepa Mit-1 produziu bastante protease quando vários aminoácidos foram empregados como única fonte de nitrogênio. Substratos crus, como melaço, soro de leite e farinha de trigo, tiveram um efeito significativo na produção da enzima. Os resultados são bastante interessantes, considerando que somente poucos actinomicetos, especialmente os halotolerantes, já foram explorados por seu potencial de produção de enzimas e otimização de processos.

Characterization and stability of extracellular alkaline proteases from halophilic and alkaliphilic bacteria isolated from saline habitat of coastal Gujarat, India

The present study deals with the isolation and characterization of the moderately halophilic-alkaliphilic bacteria from a saline habitat in western India. Eight different bacterial strains were isolated using enrichment techniques at 20 percent (w/v) NaCl and pH 10. The isolates exhibited diversity towards gram's reaction, colony and cell morphology. They were able to grow and produce alkaline protease over a broad range of NaCl, 5-20 percent (w/v) and pH, 8-10. None of the isolates could grow at pH 7, and one could not grow even at pH 8. Crude and partially purified proteases from strain S5 were subjected to characterization with reference to pH, salt stability and protein folding. Optimum protease activity and stability was recorded at 10 percent salt and pH 9-9.5. Denaturation kinetics of S5 alkaline protease along with a reference protease was studied at 8M urea followed by renaturation. The S5 alkaline protease could be partially renatured up to 32 percent of the original activity. Despite of the fact that all the 8 isolates were from the same site, they displayed significant diversity with respect to their salt requirement for growth and enzyme secretion. While the effect of pH was less demarcated on growth, the protease production was significantly affected. Isolate S5 produced substantial amount of halotolerant and alkaline protease. The activity and stability of the alkaline protease in a broader range of pH and salt would definitely make this enzyme an important candidate for various industrial applications.

O presente estudo relata o isolamento e caracterização de bactérias moderadamente halofilicas e alcalífilicas de um habitat salino no oeste da índia. Oito cepas diferentes de bactérias foram isoladas empregando técnicas de enriquecimento em NaCl a 20 por cento (p/v) e pH 10. As cepas apresentaram diversidade em relação à coloração de Gram e à morfologia das colônias e células. As cepas foram capazes de multiplicar e produzir protease alcalina em uma ampla faixa de concentração de NaCl (5 a 20 por cento) e pH (8 a 10). Nenhuma das cepas foi capaz de se multiplicar em pH 7, e uma não se multiplicou nem em pH 8.0. Proteases naturais e parcialmente purificadas da cepa S5 foram submetidas à caracterização com relação ao pH, estabilidade salina, e estrutura protéica. Atividade e estabilidade ótimas da protease foram obtidas com 10 por cento de sal e pH 9-9,5. A cinética de denaturação da protease de S5, juntamente com uma protease de referencia, foi avaliada com uréia 8M seguida de renaturação. A protease alcalina de S5 foi renaturada a 32 por cento da atividade original. Apesar de provenientes do mesmo local, as oito cepas mostraram grande diversidade em relação à exigência de sal para multiplicação e secreção enzimática. Enquanto o efeito do pH na multiplicação foi menos marcante, o efeito na produção de protease foi significativamente afetada. A cepa S5 produziu uma quantidade substancial de protease alcalina e halotolerante. A atividade e estabilidade da protease alcalina em uma faixa mais ampla de pH e sal tornam essa enzima uma importante candidata para diversas aplicações industriais.