Burkholderia cepacia causing liver and splenic abscess: Two case reports

Burkholderia cepacia infections are common among immunocompromised patients but multiple reports have shown that it can affect immunocompetent patients also. We are reporting two patients with multiple liver and splenic abscesses caused by Burkholderia cepacia. First case is a 54-year-old diabetic male presenting with fever, abdominal pain, bilateral lower limb weakness, and incontinence of urine. Second case is a 41-year-old male presenting with fever and confusion. Both had liver and splenic abscesses. Pus aspirated from the abscesses grew Burkholderia cepacia. Both responded to cotrimoxazole. Our case report emphasizes growing incidence of Burkholderia cepacia in immunocompetent patients.

Extraction and Characterisation of Flavoured Tobacco by GC-MS Studies and Validation of Results by GC-FID to Investigate Hazardous Flavour Ingredients

Flavoured tobacco is mainly consumed in India and neighbouring countries like Pakistan, Afghanistan, and Nepal and the hazards are known. Considering the need to identify such flavouring ingredients and a simple analytical method was required to quantify such favouring ingredients and hazardous / allergens, we selected top brands available in India for investigation. We simply extracted the ingredients by triturating with Diethyl Ether, evaporating solvent ether and reconstituting the extract in Acetone & Ethanol for GC-MS & GC-FID work respectively. The flavour ingredients were identified, and hazardous ingredients, viz. Diethyl Phthalate was identified. It was found around 2.5% to 3.0%. The GC-MS method was validated with GC-FID analysis with Linearity, LOD & LOQ study.

Effects of S-Amlodipine in the Management of Hypertension in Mongolian Patients

Objective: To evaluate the efficacy and safety of S-Amlodipine in patients suffering from hypertension. Materials and Methods: A multicenter, prospective, open-label, non-comparative, clinical trial was conducted on 364 patients with hypertension in Mongolia. All these patients were treated with S- Amlodipine 2.5 mg or 5 mg orally once daily for a duration of 8 weeks. Results: S-Amlodipine treatment resulted in a considerable drop in blood pressure from baseline. After 8 weeks of treatment, the mean systolic blood pressure had decreased by 12.06 mmHg and the mean diastolic blood pressure had decreased by 8.77 mmHg. Furthermore, both physicians and patients assessed the overall efficacy and rated it as good. Also, during the therapy period, 6 individuals (1.7%) experienced minor or slight adverse symptoms such as cough and headache. Conclusion: The current study confirms that treatment with S-Amlodipine was effective and well-tolerated in the management of hypertension.

Disseminated epithelial cancers—An autopsy analysis

Background: Cancer is one of the leading causes of death due to noncommunicable diseases worldwide. Despite increasing public awareness and availability of sophisticated imaging techniques, some cancers evade clinical diagnosis and/or are incidentally encountered at autopsies, often with dissemination. Aims: The present study evaluated the disseminated epithelial cancers at autopsy. Materials and Methods: This is a retrospective observational 5-year autopsy analysis of disseminated epithelial cancers performed at a tertiary-care hospital. The cases were categorized as (1) clinically diagnosed malignancy, known primary; (2) clinically diagnosed malignancy, unknown primary; and (3) clinically undiagnosed malignancy. Statistical Analysis: Nil. Results: Dissemination was identified in 66 (57.9%) of the 114 patients with epithelial malignancies. There were 29 patients (43.9%) in category 1, 26 patients (39.4%) in category 2, and 11 patients (16.7%) in category 3, majority of whom were women (38 patients, 57.6%). When all categories were considered together, lung and colorectal carcinomas were the commonest cancers seen in 13 (19.7%) and 8 (12.1%) patients, respectively, in both men and women. Majority of the patients (43 cases, 65.2%) had symptoms produced by metastases, which were the sole manifestations in 13 patients (19.7%). Lungs and liver were the common metastatic sites. Conclusions: Cancerous dissemination continues to be a major cause of morbidity and mortality even after considerable improvements in the surgical or nonsurgical treatment modalities. An autopsy study can provide important clinical insights in retrospect.

Maggots In Oral Cavity (Oral Myiasis): A Case Report

Oral myiasis is a relatively rare and uncommon clinical condition arising from the invasion of body tissues or cavities of living animals or humans by maggots or larvae of certain species of flies. This condition may be observed in suppurative oral lesions, alcoholism, senility and also maintaining poor oral hygiene by patients during orthodontic treatment, invasion and growth of larvae during and after maxillofacial injuries. The current article presents with management of oral myiasis during orthodontic treatment, and in oral and maxillofacial injuries.

Identification of microbial agents in culture-negative brain abscess samples by 16S/18S rRNA gene PCR and sequencing

@#Despite clinical suspicion of an infection, brain abscess samples are often culture-negative in routine microbiological testing. Direct PCR of such samples enables the identification of microbes that may be fastidious, non-viable, or unculturable. Brain abscess samples (n = 217) from neurosurgical patients were subjected to broad range 16S rRNA gene PCR and sequencing for bacteria. All these samples and seven formalin-fixed paraffin-embedded tissue (FFPE) samples were subjected to species-specific 18S rRNA PCR for neurotropic free-living amoeba that harbour pathogenic bacteria. The concordance between smear and/or culture and PCR was 69%. One-third of the samples were smear- and culture-negative for bacterial agents. However, 88% of these culture-negative samples showed the presence of bacterial 16S rRNA by PCR. Sanger sequencing of 27 selected samples showed anaerobic/fastidious gram negative bacteria (GNB, 38%), facultative Streptococci (35%), and aerobic GNB (27%). Targeted metagenomics sequencing of three samples showed multiple bacterial species, including anaerobic and non-culturable bacteria. One FFPE tissue revealed the presence of Acanthamoeba 18S rRNA. None of the frozen brain abscess samples tested was positive for 18S rRNA of Acanthamoeba or Balamuthia mandrillaris. The microbial 16/18S rRNA PCR and sequencing outperformed culture in detecting anaerobes, facultative Streptococci and FLA in brain abscess samples. Genetic analyses of 16S/18S sequences, either through Sanger or metagenomic sequencing, will be an essential diagnostic technology to be included for diagnosing culture-negative brain abscess samples. Characterizing the microbiome of culture-negative brain abscess samples by molecular methods could enable detection and/or treatment of the source of infection.

Awareness, Knowledge and Adaptation Practices of Farm Women in Relation to Climate Change in Northern Transitional Zone of Karnataka

Anthropogenic climate change is the topmost contemporary global issue. Climate change can potentially upset the rhythm of nature threatening the very existence of life on earth. Anthropogenic greenhouse gas emissions have increased since the pre-industrial era, driven largely by economic and population growth, and are now higher than ever. Their effects, together with those of other anthropogenic drivers, have been detected throughout the climate system and are extremely likely to have been the dominant cause of the observed warming since the mid-20th century. Further, relative to 1986-2015, warming is projected between 2.6 to 4.8°C under RCP8.5 (Representative Concentration Pathway) by the end of 21st century. So, climate change is the biggest threat to agriculture in countries around the globe as well as in India. Farmers in India are not fully aware of climate change and its indicators, causes, and impacts. Therefore, this study was conducted to know the awareness level, knowledge and adaptation practices of farm women regarding climate change. This study was conducted during 2018-19 under All India Co-ordinated Research Project on Home Science in Sulla village of Dharwad district. Simple random sampling technique was used to select 100 farm women in the village. A pre tested interview schedule was used to collect the data. Descriptive statistics were used for analysis of the data. The study revealed that all of the respondents were not aware about the increase in melting of glacier, cold wave and frequent flood. It was observed from the study that, 36 per cent of the farm women belonged to low category of awareness on indicators on climate change. It was also noticed that all of the women were not aware about changes in farming system in present climate condition. Results show that women were not aware about rapid urbanization, use of pesticides, natural disaster, burning of fossils and farm waste, use of electrical appliances and global warming as the causes of climate change. Moreover, all of the women adopted change in planting calendar, adoption of crop rotation and adoption of intercropping.

The Current Status And Perspectives For The Emerging Pandemic: Covid-19

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the extremely communicable viral infection coronavirus disease 19 (covid-19). Initially the virus was found at Wuhan, china which spread across the world exponentially and in a very short span. This outbreak has turned out to be a global health crisis and recently WHO regarded it as pandemic. The origin of the virus is predicted as either the natural selection in animal host prior to the transfer of the pathogen from animals to humans or the natural selection in humans and following transfer. Nevertheless, there is an extensive spread of virus by human to human transfer in the form of droplets. A few antiviral drugs are at the stage of clinical trials to eradicate the covid-19. In this review, a comprehensive approach is put forth to scrutinise the etiology, pathogenicity and transmission of SARS CoV-2. The review also deliberates broadly on the diagnosis and status of therapeutic treatment developed. It also focuses on the preventive and controlling measures from different sectors of the society. The review covers the details reported in 70 studies which were chosen after keyword searches carried out leading to over 884 resulting articles.

Effect of Seed Hydropriming on Seedling Emergence and Growth of Chickpea (Cicer arietinum L.) under Adverse Climatic Condition of Drought and Salinity

Aim: Assessment of influence of seed hydropriming in seed and seedling vigour enhancement for stress tolerance in chickpea which is important for successful crop production under erratic climate change causing drought and salinity stress severely affecting the seedling emergence and establishment especially in arid and semi arid regions of the world. Study Design: A three factorial randomised block design was used in the study, involving seed hydropriming treatment, chickpea varieties and growth conditions. Place and Duration of the Study: The experiment was conducted in Department of Seed Science and Technology, University of Agricultural Sciences, Dharwad, India, during the year 2018. Methodology: Six months old chickpea seeds of variety JG-11 and Annigeri-1 were hydroprimed for 12 hours at 25°C in dark condition. The primed and unprimed control seeds are sown under normal, drought and salinity conditions imposed in pots under controlled conditions. The data recorded were analysed for Analysis of Variance (ANNOVA). Results: The result of the experiment revealed that, upon seed hydropriming an average of 19 per cent increase in seedling emergence and 53.3 per cent increase in seedling vigour index was observed as compared to unprimed control seeds irrespective of variety and the abiotic stress conditions.

Evaluation Of Anticonvulsant Activity Of Ethanolic Extract Of Leaves Of Cajanus Cajan (L) Millsp. In Rodents

Cajanus cajan (L) Millsp. is the perennial plant belongs to family Fabaceae, commonly called as Pigeon pea plant. The presence of phytoconstituents like flavonoids, the flavanone (substituted) from Cajanus cajan (L) Millsp. have in vitro neuroactive property. This flavanone named as pinostrobin helps to inhibit voltage – gated sodium channels. Because of its bioactive phytoconstituents it may act as antiepileptic drug. To avoid problems like ADR herbal plant might be alternative to treat epilepsy. The current study was therefore carried out to evaluate antiepileptic activity of Ethanolic extract of leaves of Cajanus cajan in rodents. The effect of ELECC in MES-induced convulsions in rat and PTZ-induced convulsion in mice was evaluated using doses 100 mg/kg and 200 mg/kg for 7 days. Phenytoin (25 mg/kg), Diazepam (4 mg/kg) was used as standard drug for respective model. Depending on the model, outcome measures were abolishment of Hind Limb Tonic Extensor phase in MES-induced convulsion in rat and onset of latency, recovery or death in PTZ-induced convulsion in mice as well as biochemical estimation of amino acid neurotransmitter (GABA, Glutamate) were evaluated. The ELECC at doses 100 and 200 mg/kg significantly delayed the HLTE phase in MES-induced convulsions in rat whereas, significantly increased onset of latency in PTZ-induced convulsion in mice. It also showed significant (p>0.0001) effect on the level of GABA and Glutamate in dose dependent manner in both models. The phytochemical study of C. cajan showed the presence of Glycosides, Flavonoids, Flavonones, Steroids, Tannins, Fixed oil, Fatty acids and Proteins. As the flavonoids present in C. cajan may contribute to the anticonvulsant activity of the plant. Therefore, the presence of such compounds in the extract may be responsible for the anticonvulsant effect. Therefore, present study validates its anticonvulsant activity. Further, research is required to elucidate its specific mechanism of action and isolation of responsible active principles.

Effect of different methods of pasteurization on bactericidal action of human milk: A prospective observational study

Background & objectives: Pasteurization involves not only inactivation of pathogens, but also loss of immunological functions and bactericidal action of human milk. Hence, this study was aimed to explore the stability of such bactericidal action after subjecting human milk samples to thermal pasteurization under different condition of time and temperature. Methods: In this observational study 48 human milk samples were analyzed over a period of three months. The effect of holder and flash methods of pasteurization on bactericidal action against Escherichia coli was evaluated compared to the control sample before and after 72 h of storage at ?18癈. Results: Both holder and flash methods of pasteurization showed significant reduction in the E. coli growth to 46.4 and 25.5 per cent, respectively, after 24 h of incubation (P <0.001). The bactericidal activity was significantly more in samples subjected to holder method compared to flash method before and after 72 h of storage (46.41�.38 vs. 25.50�.74, P <0.001 and 42.27�.38 vs. 18.33�.55, P <0.001). Interpretation & conclusions: Our results showed that the bactericidal activity of human milk was better preserved by the holder method of pasteurization. Further well-powered and well-designed randomized trials are needed to confirm the findings.

Peptic Ulcer Healing Activity Of Fruit Pulp Extract And Seed Oil Of Adansonia Digitata Linn

Adansonia digitata (AD) Linn has been used to cure PU in Ayurveda but its efficacy has not been validated. The current study was so carried out to evaluate the antiulcer activity of ethanolic extract of Adansonia digitata fruit pulp (ADFP), n hexane extract of Adansonia digitata seed oil (ADSO) & their combination (ADFP+ADSO) in rats. The effect of AD on gastric ulcer in pylorus ligation induced and ethanol induced models was studied using doses [ADFO (500 mg/kg), ADSO (300 mg/kg) & combination of ADFP & ADSO] for 10 days. Omeprazole (10 mg/kg) were used as the standard drug. Depending on the model, outcomes measures were gastric volume, pH, free acidity, total acidity, ulcer index, percentage inhibition of ulcer index, protein, pepsin, mucus, antioxidant marker enzyme level (Superoxide dismutase, Catalase, Lipid peroxidation), morphological & Histopathological study. The result obtained with combination was set up near to the standard drug and consequence showed that the combination of ADFP & ADSO was found to be more effective than the individual extract of AD. The outcomes were statistically evaluated with the one-way ANOVA followed by the test of Dennett’s‘t’. The secondary-metabolites such as flavonoids, proteins, saponins, tannins, phenols, terpenoids, alkaloids and Fatty acids (palmitic acid, oleic acid, linoleic acid) are potent as antioxidant, antiulcer and anti-inflammatory. The finding of this reading confirmed that AD has antiulcer activity due to 1 or more of the secondary-metabolites present in it. Therefore, this study validates its antiulcer use in Ayurveda. Future investigation on separation of specific phytochemicals and elucidate MOA are needed.

A study of clinical manifestations and complications of dengue fever in medical college hospital

Background: Dengue, the most common arboviral disease worldwide is usually endemic but several epidemics have been recorded. Global incidence of dengue has grown dramatically in recent decades; about half of the world's population is now at risk. The situation in India is reflected by occurrence of major disease outbreaks from time to time over the last few decades. Objectives: The objective of the present study was to observe the various clinical manifestations and complications of dengue fever. Materials and Methods: Study included 100 patients admitted to medicine ward in medical college hospital for a period of 6 months with symptoms and signs suggestive of dengue fever and those positive for NS1Ag, IgM and IgG dengue antibodies using Rapid strip test. Results: Among 100 patients observed, majority cases were dengue fever (92%) with no mortality, 5% were dengue hemorrhagic fever (DHF) with mortality 20% and 3% were dengue shock syndrome (DSS) with mortality 67%. 71 were males and 29 were females with sex ratio 2.5:1. Maximum patients were in the age group of 18-30years. Most common clinical manifestations were fever (100%), headache (90%), abdominal pain (72%), arthralgia (65%), myalgia (64%), hepatomegaly (52%) and splenomegaly (41%). Thrombocytopenia (84%) is the most common hematological abnormality observed. Among serology positivity, majority were positive for NS1 antigen (81%), followed by IgM antibodies (7%) and mixed positivity (12%). Most common complication observed was hepatic dysfunction (33%). Conclusion: Dengue infection is common viral infection with varying clinical manifestations from region to region and epidemic to epidemic. Even though no specific treatment available for dengue fever but early diagnosis and timely intervention will prevent complications and mortality from dengue hemorrhagic fever and dengue shock syndrome.

Cytogenetic Analysis Of Down Syndrome

Objective: Down syndrome is a common genetic disease, diagnosed with congenital malformation/mental retardation. Down syndrome occurs in all races & economic levels. It is caused by third copy of chromosome 21, there are there forms of DS. Simple Trisomy 21, Translocation Trisomy and Mosaic Trisomy. The aim of the study is to know cause of Down syndrome. Chromosomal analysis was carried out by G banding technique. Materials and Methods: 1 ml of peripheral blood samples were collected in Out Patient Department of pediatrics and Cytogenetic analysis was per-formed. Results: Out of 28, 3 female cases, 2 male cases were Down syndrome, All the 5 cases were free trisomy 21, which is common type of Down syndrome; we have not identified Robertsonian translocation and mosaic type of DS. Conclusion: The present analysis shows that genetic risk factors are responsible for the incidence of Down syndrome.

Molecular genotyping of clinically important blood group antigens in patients with thalassaemia

Background & objectives: In multitransfused thalassaemic patients, haemagglutination fails to phenotype the patient's blood group antigens due to the presence of donor-derived erythrocytes. DNA-based methods can overcome the limitations of haemagglutination and can be used to determine the correct antigen profile of these patients. This will facilitate the procurement of antigen-matched blood for transfusion to multitransfused patients. Thus, the aim of this study was to compare the serological phenotyping of common and clinically important antigens of Rh, Duffy, Kell, Kidd and MNS blood group systems with molecular genotyping amongst multitransfused thalassaemic patients. Methods: Blood samples from 200 patients with thalassaemia and 100 'O' group regular blood donors were tested using standard serological techniques and polymerase chain reaction-based methods for common antigens/alleles (C, c, D, E, e, Fya, Fyb, Jka, Jkb, K, k, M, N, S, s). Results: Genotyping and phenotyping results were discordant in 77 per cent of thalassaemic patients for five pairs of antithetical antigens of Rh, Duffy, Kell and Kidd blood group systems. In the MNS blood group system, 59.1 per cent of patients showed discrepancy. The rate of alloimmunization among thalassaemics was 7.5 per cent. Interpretation & conclusions: Molecular genotyping enabled the determination of the actual antigen profile in multitransfused thalassaemia patients. This would help reduce the problem of alloimmunization in such patients and would also aid in the better management of transfusion therapy.

Photo distributed Leprosy- An atypical case of Borderline Lepromatous Leprosy

A 43 year-old-women presented with multiple red raised skin lesions over her body. Clinical and histopathological examination confirmed a diagnosis of borderline lepromatous leprosy with type 2 lepra reaction. The lesions were strikingly limited over sun exposed areas. This case represents a rare instance of photo distributed borderline lepromatous leprosy.

Frequency, distribution, and immunomorphologic characteristics of peripheral T-cell lymphoma, not otherwise specified in a tertiary care center in Southern India

Aims: In world literature, Peripheral T-cell lymphomas (PTCLs) constituted about 12% of non-Hodgkin's lymphomas (NHL) of which PTCL not otherwise specified (NOS) was the most common subtype. This study was undertaken to ascertain the frequency and to assess the morphologic and immunophenotypic characteristics of PTCL, NOS over a period of 5 years in a tertiary care referral center in Southern India. Materials and Methods: Slides and blocks of all PTCL, NOS were retrieved, and a detailed morphologic and immunophenotypic study using a wide panel of antibodies was done. Results: During this study, NHL constitutes 77.61% of all lymphomas. PTCL formed about 12.55% (251 cases) of all NHL. PTCL NOS was the most common subtype (30.68%). The most common site of involvement was lymph nodes (75%) followed by extranodal sites such as soft tissue (8.33%), gastrointestinal tract including oral cavity (6.67%), nasal cavity (5%), central nervous system (1.67%), lung (1.67%), and spleen (1.67%). PTCL, NOS showed a broad morphologic spectrum and had varied morphologic patterns with some mimicking reactive hyperplasia and some mimicking known type of T-cell lymphomas, B-cell lymphomas, and Hodgkin's lymphoma. Conclusions: PTCL, NOS constituted about 30.68% of all PTCLs in our institution during a 5-year period and was the second most common type of PTCL. Immunophenotyping using a wide panel of T-cell antibodies is necessary to distinguish PTCL, NOS from other lymphomas which they mimic, as they are known to carry a worse prognosis.

Everolimus plus octreotide long-acting repeatable in advanced neuroendocrine tumors in the routine tertiary cancer care setting: An Indian experience.

BACKGROUND: Neuroendocrine tumors (NETs) are rare, heterogeneous, indolent tumors that are relatively insensitive to systemic chemotherapy. Therapeutic strategies for NETs broadly include somatostatin analogs, antiangiogenic therapy, and most recently, mammalian target of rapamycin inhibition. Combination therapy has shown promising antitumor activity and good tolerability in the randomized phase III trials. AIM: The aim was to evaluate the safety and efficacy of Everolimus plus Octreotide long‑acting repeatable (LAR) in patients with advanced NETs in the routine tertiary cancer care setting in India in this postapproval, noninterventional trial. PATIENTS AND METHODS: Patients presenting to selected centers between 2011 and 2013 with histologically confirmed low‑, intermediate‑ or high‑grade advanced NETs who may have had prior exposure to cytotoxic chemotherapy (≤2 lines) were treated with oral Everolimus (10 mg/day) plus intramuscular Octreotide LAR (30 mg once every 28 days) until disease progression or unacceptable toxicity was seen. Patients were evaluated every 3 months for a response to therapy as per Response Evaluation Criteria in Solid Tumors. RESULTS: Everolimus plus Octreotide LAR was associated with a clinical benefit rate of 69% (best evaluable responses: Stable disease [SD] in 10 patients [63%], partial response in 1 patient [6%]). The average duration of therapy was 4.8 cycles, and 3 (17%) patients continued therapy for ≥12 cycles (all achieved SD). The therapy was found to be well‑tolerated in all patients. CONCLUSIONS: Everolimus plus Octreotide LAR appears to be safe and efficacious in patients with advanced NETs who may have had prior exposure to chemotherapy – a finding consistent with recently conducted major trials.

Eribulin mesylate in Indian patients: A single center experience.

BACKGROUND: Eribulin mesylate is the latest addition in the armamentarium of management of metastatic breast cancer (MBC) with a unique mechanism of action. Although the multicentric EMBRACE trial suggests significant overall survival benefit from this novel drug, its effectiveness in Indian population is yet to be evaluated. MATERIALS AND METHODS: Presented here is a single center experience of eight patients who were administered eribulin for MBC. Patients had received a median of 3 prior chemotherapies before eribulin administration. The median dose of eribulin therapy was 5 cycles (range: 2–6 cycles). RESULTS: The objective response rate was 75% (CR in one and PR in five out of eight patients). Response was seen across all subtypes of patients. Eribulin was well tolerated. No serious adverse events were reported. CONCLUSION: Eribulin conferred good response rates with satisfactory tolerability profile in Indian patients. Its use in earlier lines and in combination with other drugs may achieve deeper and longer responses.