Intrastromal voriconazole: An adjuvant approach for recalcitrant mycotic keratitis

Purpose: To evaluate the efficacy of intrastromal voriconazole for the management of fungal keratitis not responding to conventional therapy. Methods: Patients having microbiologically proven fungal keratitis with poor response to 2 weeks of conventional topical therapy were included in the study. After obtaining informed consent, an intrastromal injection of voriconazole was administered around the ulcer. Response to treatment in the form reduction in the size of the ulcer and infiltration was recorded on regular follow-ups. Results: Out of a total of 20 patients, 14 responded to intrastromal treatment and resolved, whereas six patients progressed to perforation. Mean resolution time was 35.5 � 9.2 days. The most common organism isolated was Fusarium in six patients while Aspergillus and Mucor were isolated in two each. The causative organism could not be isolated in eight patients. The size of the ulcer at presentation and height of hypopyon were found to be significant risk factors associated with treatment outcomes. Conclusion: Intrastromal voriconazole as an adjuvant therapy appeared to be effective in treatment of fungal keratomycosis not responding to conventional therapy, thus, reducing the need for therapeutic or tectonic keratoplasty.

Why people avoid prescribed medical treatment in India?

Avoidance in seeking prescribed medical treatment can result in adverse consequences. The study was conducted to find out the reasons to avoid prescribed medical treatment and associations with various socioeconomic variables in India. Data from the National Sample Survey Organisation 71st Round on “Key Indicators of Social Consumption: Health” (January and June 2014) have been used. Variables such as place of residence, social categories, religion, and socioeconomic status have been used to study the associations with the various reasons to avoid prescribed medical treatment. Nonseriousness about the ailment was found to be the primary reason for not seeking prescribed medical treatment. Lack of availability of medical facility, long-waiting time, and financial constraints were other important reasons. Understanding the socioeconomic differentials among the reasons why people avoid prescribed medical treatment is critical in improving the effectiveness of health-care facilities in India.

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.

Vertebro-cerebral cryptococcosis mimicking tuberculosis: A diagnostic dilemma in countries with high burden of tuberculosis.

We report a case of a 30-year-old immunocompetent man with disseminated cryptococcosis who was initially treated with antitubercular therapy due to clinical and radiological diagnosis of vertebro-cerebral tuberculosis. The diagnosis of Cryptococcus infection was made due to incidental isolation of this fungus from blood culture with negative cerebrospinal fluid culture results. Though disseminated cryptococcosis with central nervous system, skeletal, and skin involvement is an uncommon manifestation of Cryptococcus neoformans infection, a high clinical suspicion and early initiation of therapy is needed to recognise and treat such patients efficiently.

Role of Borna Disease Virus in neuropsychiatric illnesses : Are we inching closer.

The biological cause of psychiatric illnesses continues to be under intense scrutiny. Among the various neurotropic viruses, Borna disease virus (BDV) is another virus that preferentially targets the neurons of the limbic system and has been shown to be associated with behavioural abnormalities. Presence of various BDV markers, including viral RNA, in patients with affective and mood disorders have triggered ongoing debate worldwide regarding its aetiopathogenic relationship. This article analyses its current state of knowledge and recent advances in diagnosis in order to prove or refute the association of BDV in causation of human neuropsychiatric disorders. This emerging viral causative association of behavioural disorders, which seems to be inching closer, has implication not only for a paradigm shift in the treatment and management of neuropsychiatric illnesses but also has an important impact on the public health systems.

Biosocial Correlates of Nutrition and Chronic Energy Deficiency among Adult Females of two Ecological Zones in Madhya Pradesh and Uttarakhand, India

The paper aims to draw out biosocial correlates of nutrition through body mass index (BMI) and chronic energy deficiency (CED). The findings are based on cross-sectional data of 446 women aged 18-60 years from six different endogamous groups of two ecological zones. The mean age of studied women varied from 31 to 36 years. The mean age at menarche was found to be 14.50±1.32 years. Similarly mean age at menopause was found to be 46.22±4.00 years. The mean of reproductive life span varied from 27 to 35 years. Average number of pregnancies per women was 4.44±2.52, average foetal loss was 0.11, children surviving per women was 3.61, whereas average child loss per women was found to be 0.62 and average family size was 9.51. Variations in mean BMI kg/m2 between populations ranged between 18.56 and 20.71. Prevalence of CED was highest among the Brahmin women of Uttarakhand (58.3%) followed by Ahirwar of Madhya Pradesh (47.1%). Incidence of CED was found lowest among Brahmin women of Madhya Pradesh (24.0%). Linear regression coefficient (b ± standard error) of BMI on Cormic Index for these women was 33.1 ± 8.1 (t=4.0, p=0.001), and correlation coefficient (R) was 0.189. Out of 6 anthropometric variables considered for regression analysis, 5, namely weight, hip circumference, waist circumference, mid arm circumference and sitting height showed significant correlations with BMI. Significant differences in sitting height and Cormic Index of women from the hills and plains indicate the role of ecology in shaping its habitants. Out of 9 demographic variables, only age of respondent and family size were found to have a significant impact on low BMI status. The present study postulates that the nutritional status of women has improved over the last decades.

Cutaneous infection with Mycobacterium fortuitum: an unusual presentation.

Cutaneous infection with rapidly growing mycobacteria is uncommon and its diagnosis can be missed unless there is strong clinical suspicion coupled with microbiological confirmation. We report a case of localized recurrent soft tissue swelling of the foot by Mycobacterium fortuitum in a healthy adult male. The case is being reported for its uncommon clinical presentation and the associated etiological agent. The patient recovered completely following therapy with amikacin and clarithromycin.

Microbial decolorization and bioremediation of melanoidin containing molasses spent wash.

Molasses spent wash from cane-molasses based distilleries contains a brown coloured recalcitrantpolymer melanoidin, which if disposed untreated poses a great threat to environment. Microbial decolorization and chemical oxygen demand (COD) reduction was found to be dependent on specific carbon and nitrogen source. Under optimal condition of pH, carbon and nitrogen concentration for each treatment, it was found that Bacillus sp isolated from soil was capable of removing COD (85. 35%) and colour (81.10%) from distillery waste to the maximum extent after 9 days atpH 7 in the medium containing 0.5% peptone, 2% glucose and 10% (v/v), followed by Phanerochaete chrysosporium and lowest reduction was obtained by using native microbial consortium.

Poison as cure: a clinical review of botulinum toxin as an invaluable drug

Botulinum toxin is the most potent toxin known. It is readily absorbed from mucosal surfaces. If dispersed as an aerosol or mixed in the food or water it can lead to a large outbreak of botulism. The disease presents as a symmetric descending paralysis in an afebrile patient. Cranial nerve involvement with diplopia, dysarthria, dysphonia, dysphagia and respiratory paralysis is seen after a variable incubation period. The treatment is mainly supportive. The source of the toxin is Clostridium botulinum, an anaerobic gram-positive spore-forming organism. Some other species of Clostridium like C. butyricum and C. baratii also produce the toxin. The toxin is heat labile and can be inactivated by heating at 100°C for 10 minutes. The toxin acts at the peripheral cholinergic nerve terminals at the neuromuscular junctions, postganglionic parasympathetic ganglia, etc, and affects neurotransmitter release by inhibiting exocytosis. Clinical uses in various medical fields were found for it.(AU)

Correlates of tobacco-use pattern amongst adolescents in two schools of New Delhi, India.

BACKGROUND: As adolescent tobacco use has been found to be a major predictor of future use, preventive efforts need to be focused on this section of population. OBJECTIVES: To assess the role of knowledge regarding tobacco, risk-taking attitude, peers, and other influencers on tobacco and areca nut use, amongst adolescents. SETTINGS AND DESIGN: A school-based cross-sectional study covering two schools. Students of classes IX and XI, of selected schools, participated in the study (n = 596). METHODS: A pretested and validated, close ended, self-administered questionnaire was used. Sociodemographic factors, awareness regarding tobacco, risk-taking attitudes, role of peers and other influencers, and tobacco, areca nut and alcohol use, were studied. STATISTICAL ANALYSIS: Point estimates, 98% Confidence Intervals, tests of significance, bivariate and multivariate analysis (multiple logistic regression). RESULTS: Almost 42% of tobacco users started before the age of 12 years. Peer pressure, general stress, and media were important influencers. Logistic regression analysis showed that students in public school were using more tobacco [Odds ratio (OR) = 1.85, P = 0.174] and tobacco/areca nut (OR = 1.14, P = 0.02). The difference in use between the genders and class in which studying was statistically not significant. Lesser proportion of those possessing adequate knowledge regarding tobacco used it as compared to those without adequate knowledge (OR = 0.13, P < 0.001) however, possession of adequate knowledge was not a good predictor of areca nut consumption (OR = 0.86, P = 0.585). The most important correlate for tobacco use (OR = 6.41, P < 0.001) and areca nut use (OR = 11.17, P < 0.001) was risk-taking attitude. CONCLUSION: Multi-pronged and concerted efforts targeting children at an early age are required to prevent tobacco and areca nut use among adolescents.

Injection practices in a metropolis of North India: perceptions, determinants and issues of safety.

BACKGROUND: At least 50 percent of the injections administered each year are unsafe, more particularly in developing countries, posing serious health risks. An initial assessment to describe injection practices; their determinants and adverse effects can prevent injection-associated transmission of blood borne pathogens by reducing injection frequency and adoption of safe injection practices. AIMS: To assess the injection practices in a large metropolitan city encompassing varied socio-cultural scenarios. STUDY SETTING AND DESIGN: Field based cross sectional survey covering urban non-slum, slum and peri-urban areas of a large metropolitan city. METHODS AND MATERIAL: Injection prescribers, providers and community members selected by random sampling from the study areas. Pre tested questionnaires assessed knowledge and perceptions of study subjects towards injections and their possible complications. Observation of the process of injection and prescription audit also carried out. STATISTICAL ANALYSIS: MS Access for database and SPSS ver 11 for analysis. Point estimates, 95% confidence intervals, Chi Square, t test, one-way ANOVA. RESULTS: The per capita injection rate was 5.1 per year and ratio of therapeutic to immunization injections was 4.4:1. Only 22.5%of injections were administered with a sterile syringe and needle. The level of knowledge about HIV and HBV transmission by unsafe injections was satisfactory amongst prescribers and community, but inadequate amongst providers. HCV was known to a very few in all the groups. The annual incidence of needle stick injuries among providers was quite high. CONCLUSION: A locally relevant safe injection policy based on multi disciplinary approach is required to reduce number of injections, unsafe injections and their attendant complications.

Adenosine-induced ventricular fibrillation.

The use of adenosine has been suggested as a diagnostic tool in the evaluation of wide ORS complex tachycardia. However, adenosine shortens the antegrade refractoriness of accessory atrioventricular connections and may cause acceleration of the ventricular rate during atrial fibrillation. We observed ventricular fibrillation in 2 patients who presented to the emergency department with pre-excited atrial fibrillation and were given 12 mg of adenosine.

Coordinate production of cephamycin c and clavulanic acid by Streptomyces clavuligerus.

Production of cephamycin c and clavulanic acid by Streptomyces clavuligerus was investigated using different media in shake flask condition. Highest cell growth (3.8 g/L) was observed in glycerol, sucrose, proline and glutamic acid (GSPG) medium. Although, GSPG medium supported maximum growth, it was least effective for the synthesis of both cephamycin and clavulanic acid. Yield of cephamycin and clavulanic acid was maximum in dextrin and K medium, respectively. High and low level of constituents of dextrin medium, affected production of both cephamycin and clavulanic acid. Biosynthesis of clavulanic acid was associated with production of cephamycin c.

Evaluation of efficacy of Dettol-H in hospital use.

A study was conducted at Safdarjang Hospital, New Delhi, to elucidate the bactericidal effect of a new disinfectant having benzalkonium chloride (40%) + disodium edetate (1.5%) and commercially available as Dettol-H, in comparison with that of a disinfectant already in-use in this hospital and having chlorhexidine gluconate (7.5%) + cetrimide (15%) + isopropyl alcohol (commercially available as Alpilon). The modified Capacity test of Kelsey-Sykes and In-use test of Kelsey-Maurer were carried out using control strains and random gram positive and gram negative bacterial isolates from clinical specimens. The two disinfectant solutions were analysed at three dilutions viz. weak, recommended and strong. From the study it could be inferred that both Dettol-H and Alpilon were equally effective in recommended and strong dilutions against the organisms tested. Weak dilutions were not effective in both and hence Dettol-H and Alpilon are effective only if used in prescribed concentrations.

Fetus in fetu or a retroperitoneal teratoma--a controversy revisited. A case report and review of literature.

A 25 year old man male presented with a lump in the left side of the abdomen. Ultrasonography revealed an echogenic retroperitoneal mass with hyperechoic areas within it suggestive of bone. CT scan confirmed the presence of a large retroperitoneal mass with bone within it. On exploration there was a large encapsulated retroperitoneal lump. There was a soft tissue mass within the lump surrounded by a yellow pultaceous material admixed with pus. Examination of the specimen showed a bone at the cephalic end with teeth embedded within it. There were two limb buds near the cephalic end. The whole specimen was covered with skin with all its appendages. There was coelomic cavity present. The distinction between fetus in fetus and teratoma has for long been the subject of controversy. According to the criteria described by Willis, there should be a vertebral axis present to make the diagnosis of fetus in fetu. But there have been a few reports where cases have been described as fetus in fetu even in the absence of a vertebral axis. A review of the literature concerning this controversy is briefly given.

Anaerobic flora in endodontic infections.

Microbiological and clinical data from 56 patients with endodontic infections were evaluated. Samples were collected using autoclaved paper points. Specimens were processed for isolation of aerobic and anaerobic bacteria. Antimicrobial sensitivity and resistance profiles of the recovered isolates was also performed. Forty nine positive cultures (87.5%) were obtained from the 56 consecutive necrotic root canal systems which were sampled. A total of 69 aerobic bacteria and 21 anaerobic bacteria were recovered. Aerobic bacteria were isolated from 35 patients (72%), anaerobic bacteria from 3 (6%) and mixed aerobic and anaerobic bacteria from 11 patients (22%). The most common aerobic isolate was Klebsiella pneumoniae. The predominant anaerobic isolate was Bacteroides species. One isolate was recovered from 25 patients (51%) whereas in the remaining 24 patients (49%) more than 1 isolate were recovered. These data illustrate the polymicrobial nature of endodontic infections in half the patients studied and the role of anaerobic bacteria in a quarter of them.