Retinopathy of prematurity: Maharashtra state model

This report describes the goal, activities, and outcomes of the Queen Elizabeth Diamond Jubilee Trust funded retinopathy of prematurity (ROP) program in the state of Maharashtra in collaboration with the Public Health Foundation of India, Hyderabad. The project was initiated in July 2016 with the goal of establishing a sustainable ROP program in the special newborn care units (SNCUs) in public health facilities of five districts. Between 2016 and 2018, ophthalmology and neonatology teams from five district hospitals (DHs) were trained by nongovernment partner hospitals in the state. Infrastructure was developed by procuring equipment for ROP screening/treatment, and awareness generation activities were conducted with a range of stakeholders. Eight ophthalmologists were trained to perform ROP screening (from five DHs and one medical college), and five neonatology teams (pediatricians and nurses) from the project hospitals were trained in best neonatal practices to prevent ROP. The Pune district's hospital was developed as an ROP treatment center. Toward the end of the project period, six new facilities had an established ROP program. The state health department is in the process of scaling up the ROP program to a larger geographic region to ensure universal ROP screening coverage in the state of Maharashtra.

Characterization of Xanthomonas campestris pv. viticola causing bacterial leaf spot of grapes in Maharashtra, India

Aim: The aim of the present study was to isolate, characterize and identify pathogenic bacteria from bacterial leaf spot infected grape vineyards of Maharashtra. Methodology: Collected diseased samples were subjected to isolation. All isolates were further subjected to different morphological and biochemical characterization. These isolates were also used to standardize inoculation methods to study host range and test pathogenicity to confirm infectivity. Genomic DNA was isolated from bacteria for phylogeneitc analysis using 16 rDNA. Results: The disease is characterized by water soaked, angular leaf spot which later turns to irregular, dark brown to black necrotic region on the leaf surface. Microbial studies confirmed that it is a Gram negative, rod shaped bacterium with white, mucoid, glistening and convex circular colonies on artificial medium. Pathogenicity test was performed to confirm virulence. Phylogenetic analysis of 16S rDNA gene exhibited more than 99% similarity with other Xanthomonas campestris pv. viticola. The bacterium was found resistant to vancomycin, peniciliin and oxacillin antibiotics. The bacterium is also capable of infecting Mangifera indica and Citrus limon along with eight weed species.

Salivary Gland Tumors - A Three Year Retrospective Study

Neoplastic lesions of salivary gland are uncommon and shows varied morphology. It comprises 5-6 % of all tumors of head and neck. Salivary neoplasms are more likely to occur in relatively old age (6th decade). Benign salivary gland tumors usually occur relatively earlier (4th-5th decade) than malignant tumors. Tumors of salivary glands usually present as mass in otherwise normal gland. Uncommon presenting complaints such as facial paralysis in presence of neoplastic growth usually suggest malignant tumor invading facial nerve. Our aim is to study the epidemiology, clinical presentation and distribution of various salivary glands in relation to their histopathology. Methods: This was a retrospective cross-sectional study conducted in the department of pathology of a tertiary care medical centre situated in an urban area. All the salivary gland tumor specimens which were received in the department over these years were studied by analyzing records from the department. Distribution of benign and malignant salivary gland tumors, their morphology and prognostic histological parameters were studied. Statistical analysis was done using SSPS 17.0 software, with P value being less than 0.05 as statistically significant. Results: Out of 80 studied cases there were 32 males and 48 females with a M:F ratio of 1:1.5. The mean age in male and female patients was found to be 47.41 ± 15.18 and 46.72 ± 13.68 respectively. The difference in mean age of males and females was found to be statistically insignificant (P>0.05). parotid gland was most commonly involved site (68.75%) followed by submandibular gland (23.75%) and minor salivary glands (5%). Amongst benign pathologies pleomorphic adenoma was found to be the most common lesion encountered(31.25%) followed by warthin’s tumor (11.25%) and myoepithelioma (5%). The most common malignant tumor was mucoepidermoid carcinoma which was seen in 12 (17.50%) patients. Conclusion: Amongst all salivary glands, parotid gland was found to be most commonly affected. Most common benign and malignant tumors were found to be pleomorphic adenoma and mucoepidermoid carcinoma respectively.

Performance of a shipwreck as an artificial fish habitat along Goa, west coast of India

Aim: The objective of the study was to test the hypothesis that submerged shipwrecks along the western coast of India can function as artificial fish habitats with trophic structure of fish assemblages similar to natural rocky reef habitats. Methodology: The fish assemblages on shipwreck and natural reefs were analysed from September 2013 to December 2016 using diver assisted underwater visual census (UVC). Data collected on fish assemblages were used to compare the fish trophic structure between shipwreck and natural reefs using diversity indices, permutational multivariate analysis of variance and similarity percentage analysis. Results: Fish abundance was two times greater on shipwreck than on natural reefs and the major trophic guilds on shipwreck were omnivores and carnivores. Multivariate analyses showed a distinct fish trophic structure on shipwreck from that of natural reefs and certain fish species differentiated the trophic structure of shipwreck from natural reefs. The high densities of Pomadasys furcatus, P. guoraca, Pempheris multiradiata, Lutjanus indicus, L. fulvus, Ostorhinchus compressus, Epinephelus coioides, E. erythrurus, Monodactylus argenteus and Heniochus singularis contributed significantly to the average dissimilarity for fish assemblages in shipwreck from natural reefs. This has helped to differentiate the fish communities on shipwreck from natural reefs. Interpretation: This study showed that shipwreck and natural reefs differ significantly in fish trophic structure. Fish species richness and abundance were significantly higher on shipwreck than natural reefs. Therefore, the Greater species richness, abundance and diversity of fish communities on shipwreck could be a result of unique, complex and heterogeneous habitat features existing within the wreck

A Review On Chitosan Nanoparticles

The chitosan nanoparticles because of their biodegradability, biocompatibility,better stability, low toxicity, simple and mild preparation methods, offer a valuable tool tonovel drug delivery systems in the present. The methods such as micro emulsion method,emulsification solvent diffusion method are also in use. The present review describesproperties, different methods of preparation and applications of chitosan nanoparticles

Medical Officers’ Certificate Programme (MOCP) Competencey Based Curriculum Of Public Health, Maharashtra.

Background: We herewith describe a novel methodology of teaching Medical Officers working at the Primary Health Centers under the Public Health Dept. of Maharashtra State. This course intends to develop competencies to manage adult and pediatric patients with common emergencies at primary health centre. There has been an immense shortage of Pediatricians & Physicians for the last 5 years due to 50-60% vacancies. Besides this, many of the patients in rural areas need to be addressed by a Pediatrician or Physician. With this in mind a short term certificate programme for the Medical Officers was designed. Method: Medical Officers working at Primary Health Centers were deputed like resident doctor for 6 months in the Pediatric/ Medicine Dept. of a Medical College. The methodology used was videoconferencing lectures, motivational lectures by renowned Pediatricians and Physicians, Professors, Padma Awardees from Mumbai, Nagpur, Pune and Aurangabad. The sessions were interactive with active involvement of the Doctors . They also attended all postgraduate programmes of the Department of the Medical College. They attended night duties, speciality clinics like resident doctors. An examination was taken at the end of 6 months after they had learnt state-of-the-art techniques in the subject. 169 students were taught from 2011 in 4 batches till date. The passing percentage varied from 88 to 96%. Result : At the end of the training, the students had acquired sound knowledge of theory and practicals in Medicine/ Pediatrics, had acquired necessary hands on skills, learnt state-of-the-art methodology and had established linkages with teachers in Medical Colleges. Conclusion: MOCP is thus a unique course successfully working only in the State of Maharashtra in India.

Shewanella algae in acute gastroenteritis.

Shewanella algae is an emerging bacteria rarely implicated as a human pathogen. Previously reported cases of S. algae have mainly been associated with direct contact with seawater. Here we report the isolation of S. algae as the sole etiological agent from a patient suffering from acute gastroenteritis with bloody diarrhoea. The bacterium was identifi ed by automated identifi cation system and 16S rRNA gene sequence analysis. Our report highlights the importance of looking for the relatively rare aetiological agents in clinical samples that does not yield common pathogens. It also underscores the usefulness of automated systems in identifi cation of rare pathogens.

A Rare Case Of Primary Lymphonodular Cryptococcosis In Hiv Positive Patient On Anti-Retroviral Therapy

Cryptococcal infection is the most common life threatening opportunistic fungal infection in Human Immunodeficiency Virus infected individuals. (1) An early diagnosis is essential for a prompt treatment and to prevent dissemination, which is fatal. Pulmonary, intestinal, bone marrow and CNS involvement have been reported. There are only few cases of lymphonodular Cryptococcosis have been reported, we report a rare case of primary lymphonodular cryptococcosis without any pulmonary or CNS involvement. (2)

Effects of triamcinolone acetonide on human trabecular meshwork cells in vitro.

Aim: To study the effects of triamcinolone acetonide (TA) on cultured human trabecular meshwork (HTM) cells. Materials and Methods: HTM cells were cultured and treated with 125, 250, 500 and 1000 μg/mL concentration of TA for 24 h. The cells were treated with both crystalline TA (TA‑C) (commercial preparation) and solubilized TA (TA‑S). Cell viability was measured by a trypan blue dye exclusion test. The activity of caspse‑3/7 was measured by a fluorescence caspase kit and DNA laddering was evaluated by electrophoresis on 3% agarose gel. Levels of lactate dehydrogenase (LDH) were assessed with LDH cytotoxicity assay kit‑II. Results: Mean cell viabilities of HTM cells after 24 h exposure to TA‑C 125, 250, 500, and 1000 μg/mL were 75.4 ±2.45% (P < 0.0001), 49.43 ± 1.85% (P < 0.0001), 17.07 ± 2.39% (P < 0.0001), and 3.7 ± 0.9% (P < 0.0001), respectively, compared with the untreated HTM cells 92.49 ± 1.21%. The mean cell viabilities with 125, 250, 500, and 1000 μg/mL of TA‑S were 94.47 ± 1.60% (P > 0.05), 90.13 ± 0.40% (P < 0.01), 85.57 ± 0.47% (P < 0.001), and 71.67 ± 3.30% (P < 0.0001), respectively, compared to DMSO‑equivalent cultures. Untreated HTM control had a cell viability of 96.57 ± 1.98%. DMSO‑treated controls of 125, 250, 500, and 1000 μg/mL had a cell viability of 94.73 ± 0.57%, 96.97 ± 1.08%, 93.97 ± 1.85%, and 97.27 ± 1.15%, respectively. There was no increase of caspase‑3/7 activity in cultures treated with either TA‑C or TA‑S. DNA laddering showed no bands in the TA‑C or TA‑S treated cultures. There were significantly higher LDH release rates at all concentrations of TA‑C compared to TA‑S. Conclusions: Results show that the effect of TA‑C and TA‑S on HTM cells is due to cell death by necrosis at all concentrations except 125 μg/mL of TA‑S. Elevated levels of LDH confirmed necrotic cell death. Our study also infers the relative safety of TA‑S over TA‑C.

Rhizomucor variabilis : A rare causative agent of primary cutaneous zygomycosis.

Rhizomucor variabilis is a rare cause of human infections. We report a case of primary cutaneous zygomycosis in an immunocompetent host. Although microscopy reveals the fungal aetiology, the need for species identification is highlighted to better understand the species and establish an epidemiological pattern as it is reported from restricted geographical locations.

Bioassay Guided Phytometabolites Extraction for Screening of Potent Antimicrobials in Passiflora foetida L.

Passiflora is a genus belonging to the family Passifloraceae having varied species with highly therapeutic values. Tribes with traditional medicinal knowledge suggested Passiflora foetida L. as a source of high value pharmaceutical plant. Present study deals with the Isolation, Purification, characterization and bioassays of antimicrobial secondary metabolites. In spite of traditional soxhlet extraction, Cold percolation proved suitable extraction scheme. Bioassay guided TLC characterization, and purification led the effective collection of bioactive natural products. Disc diffusion method shows a potent inhibitory activity of compounds against multi drug resistant pathogenic microorganisms like S. aureus(OARS). For structural characterization bioactive products were analyzed using UV. The results confirmed the presence of polyacetylenes as active constituents in the plant.

Antinociceptive activity of Sesbania sesban (Linn) wood extracts, a preliminary study.

The wood of the plant Sesbania sesban, is reported to have antinociceptive activity. To validate its folk use in the treatment of pain, wood was extracted successively with petroleum ether, chloroform, ethyl acetate, ethanol, and water to produce respective extracts. The extracts (50 and 100 mg/kg, ip) were screened for antinociceptive activity using hot plate test and acetic acid-induced writhing test in mice. Petroleum ether, chloroform, and ethyl acetate extracts showed significant and dose-dependent activity in both the tests. In order to find out the involvement of opioid receptors, effect of naloxone (1 mg/kg, sc) on the action of extracts was checked in hot plate test. Petroleum ether, chloroform, and ethyl acetate extracts showed significant and dose dependant antinociceptive activity. The antinociceptive action of the extracts was blocked by naloxone, suggesting involvement of opioid receptors in the action.

Cancer therapeutics- opportunities, challenges and advances in drug delivery.

This review highlights the characteristics of the cancer that provide opportunities for drug delivery carriers to target cancer. These opportunities include EPR effect, high interstitial pressure of tumour, low pH of endosomes of tumor cells, overexpressed receptors, angiogenesis etc. Chemotherapy is one of the most important treatments currently available among the various approaches. The present status of chemotherapy is far from being satisfactory. Its efficacy is limited and patients have to suffer from serious side effects, some of which are life-threatening. The newer approaches to cancer treatment not only supplement the conventional chemotherapy but also aim to prevent damage to the normal tissues and overcome drug resistance. The innovative approaches of cancer treatment require new concepts of drug delivery in cancer. This concept requires the unique surface morphology which ultimately determines the fate of new drug delivery systems. The Innovative methods must also shoot out the associated problems of cancer like multidrug resistance by tumor cells. Progress in developing various controlled and targeted drug delivery systems has reviewed here with an emphasis on dendrimeric drug delivery system. Dendrimeric system appears to be promising in cancer chemotherapy especially via ligand/receptor mediated endocytosis as it posses numerous properties (especially surface property) to target cancer.

Estrogen, progesterone and HER2 receptor expression in breast tumors of patients, and their usage of HER2-targeted therapy, in a tertiary care centre in India.

Background: This study was undertaken to document the pattern of expression of estrogen (ER), progesterone (PR) and human epidermal growth factor receptor-2 (HER2) and the usage of HER2-targeted therapy in a large tertiary care hospital in India in the year 2008. Materials and Methods: The histopathology reports of all breast cancer patients registered in the hospital in 2008 were extracted from the electronic medical record system. All the cases were immunohistochemically evaluated for estrogen and progesterone receptor status (ER and PR), and c-erbB-2 protein (HER2) expression using standard immunoperoxidase method. The use of HER2-targeted therapies was evaluated by extracting relevant information from the database of the hospital pharmacy and case charts of patients enrolled in ongoing approved trials. Results: A total of 2001 new patients of invasive breast cancers with available pathology reports were registered in the hospital in the year 2008. ER and/or PR expression was positive in tumors of 1025 (51.2%) patients. HER2 3+ expression by immunohistochemistry (IHC) was found in 335 (16.7%) and HER2 2+ in 163 (8.1%). The triple negative phenotype was found in 596 (29.8%) patients. An estimated 441 patients were eligible to receive HER2-targeted therapy based on their HER2 status. Of these 38 (8.6%) patients received some form of HER2-targeted therapy; 20 patients (4.5%) as part of ongoing clinical trials and 18 (4.1%) as part of routine care. Conclusions: The overwhelming majority of patients eligible for HER2-targeted therapy in our institution are unable to receive it because of financial constraints and limited access to health insurance. There is a higher fraction of patients with the triple negative phenotype compared to the Western population.

Increased yield of smear positive pulmonary TB cases by screening patients with > or =2 weeks cough, compared to > or =3 weeks and adequacy of 2 sputum smear examinations for diagnosis.

BACKGROUND: RNTCP recommends examining three sputum smears for AFB from Chest Symptomatics (CSs) with cough of > or =3 weeks for diagnosis of Pulmonary TB (PTB). A previous multi-centric study from Tuberculosis Research centre (TRC) has shown that the yield of sputum positive cases can be increased if duration of cough for screening was reduced to > or =2 weeks. Other studies have shown that two smear examinations are adequate for diagnosis of smear positive PTB . To validate the above findings, a cross sectional multi-centric study was repeated in different settings in five geographical areas in India. METHODS: Three primary and secondary level health facilities with high out-patient attendance were selected from two Tuberculosis Units (TU) in each of the 15 selected districts to screen about 10,000 new adult outpatients from each state. For patients who did not volunteer history of cough, symptoms were elicited using a structured simple questionnaire. All the CSs were referred for sputum examination. RESULTS: A total of 96,787 out-patients were registered. Among them 69,209 (72%) were new adult out-patients. Using > or =2 weeks of cough instead of 3 weeks as the criterion for screening, there was an overall increase of 58% in CS and 23% increase in the detection of smear-positive cases. Among 211 patients, 210 were positive at least by one smear from the initial two specimens. Increase in the work-load if 2 smears were done for patients with cough of > or =2 weeks cough were 2 specimens (i.e. 13 to 15) per day for an adult OPD of 150. CONCLUSION: The yield of sputum positive PTB cases can be improved by screening patients with > or =2 weeks cough and two specimens are adequate for diagnosis.

Methicillin resistant Staphylococcus aureus infections-implications in hospital infection control.

BACKGROUND: A significant part of nosocomial infections are caused by methicillin resistant Staphylococcus aureus (MRSA). Nosocomial MRSA are known to be multidrug resistant and thus difficult to treat. METHODS: A 2 year study was conducted between January 2001 and December 2002 at Karnataka Institute of Medical Sciences Hospital, Hubli to assess the prevalence of MRSA and its antibiotic susceptibility pattern in various wards. RESULTS: S. aureus was isolated from 714 patients, 283 (37.53%) of which exhibited methicillin resistance. Although these MRSA were multidrug resistant in all the wards, the problem was more severe in NICU and orthopedic wards. CONCLUSION: The results highlight the need for effective implementation of infection control measures in the hospital. There is a need for the judicious use of antimicrobial agents in the hospital and outside as their indiscriminate use can exert pressure in selecting out MRSA and other multidrug resistant organisms.

Primary systemic amyloidosis.

We report here a case of a 35-year-old male who presented with multi-system disease, which on evaluation was found to be due to primary systemic amyloidosis. We present the myriad manifestations of this uncommon disease entity.