Aetiology of childhood viral gastroenteritis in Lucknow, north India.

Background & objectives: Due to limited availability of data on viral aetiology of acute gastroenteritis in north India, the present study was planned to detect rotavirus, norovirus, sapovirus and astrovirus in stool samples of both in hospitalized and non-hospitalized children less than five years of age presenting with acute gastroenteritis. Methods: A total of 278 stool samples from equal number of children were tested for rotavirus antigen using ELISA and for norovirus, sapovirus and astroviruses by reverse transcription (RT)-PCR. Results: Of the 169 samples from hospitalized patients, rotavirus, norovirus, sapovirus and astrovirus were detected in 19.5, 2.3, 3.5 and 2.9 per cent samples, respectively. Of the 109 samples collected from the non-hospitalized patients, frequency of rotavirus and sapovirus detection was 9.1 and 1.8 per cent, respectively while norovirus and astrovirus were not detected. Interpretation & conclusions: Rotavirus was the most frequent cause of viral gastroenteritis in both hospitalized and non-hospitalized children. Maximum positivity of the viruses was seen in children less than two years of age.

Comparison of third generation ELISA and conventional nested RT-PCR for detection of HCV among hemodialysis patients.

Hepatitis C virus is one of the main cause of chronic hepatitis in developing countries. The current study was done to evaluate the efficacy of the third generation ELISA compared to nested RT- PCR for establishing the diagnosis of hepatitis C virus (HCV) in patients on hemodialysis. This descriptive, cross-sectional study was carried out on 237 Hemodialysis patients in Lucknow, Uttar Pradesh. The retrospective demographic data of the subjects was collected and the patient’s serum samples were analyzed by ELISA & RT-PCR for HCV. In the present study, of total 21 HCV positive either by ELISA or PCR 12 (57.14%) were positive for both RT-nested PCR and ELISA. Total four (19.05%) patients were positive for HCV by RT-nested PCR and negative by ELISA while five (23.81%) patients were negative for RT-nested PCR and positive for ELISA. PCR method is accredited as a specific and reliable method suitable for screening of HCV and is recommended for establishing exact and final diagnosis of these patients. However third generation ELISA assays have many advantages in the diagnostic setting including ease of automation, ease of use, relative cost-effectiveness, and low variability.

Deep Neck Space Infections: A Profile of Fifty Nine Cases.

The present study was undertaken to analyse our experience with deep neck space infections and emphasize the importance of patient presentation, radiologic evaluation and early diagnosis and appropriate management. The records of 59 patients treated for deep neck space infections were evaluated. Odontogenic infections (35.59%) were found to be the most common cause of deep neck space infections followed by tonsillar infections (20.33%). Pain, fever, neck swelling and odynophgia were the most common clinical presentations. Radiological investigations were performed in all the patients (100%) while contrast enhanced CT - scan was performed in 35 patients (59.32%). The most commonly involved sites were the submandibular space and the parapharyngeal space, involving 14 patients and 11 patients respectively. All the patients (100%) were on intravenous antibiotics and fluids. Surgical intervention was done in 47 patients (79.66%) whereas 12 patients (20.33%) improved with conservative medical management alone. Despite the wide use of antibiotics, deep neck space infections are commonly seen. Early clinical and radiological diagnosis and appropriate management help to prevent the development of life threatening complications. Surgical drainage forms the mainstay of treatment, conservative medical therapy is also effective in selective cases.

Influenza virus genotypes circulating in and around Lucknow, Uttar Pradesh, India, during post pandemic period, August 2010 - September 2012.

Background & objectives: During the post influenza pandemic period, continuous surveillance of influenza virus and its subtypes is mandatory to help the policy makers to take effective and appropriate decisions. Therefore, this study was planned to determine the pattern of influenza virus activity in context to various meteorological and clinical parameters in and around Lucknow, Uttar Pradesh, India, during post pandemic period August 2010 - September 2012. Methods: Nasal swabs/throat swabs/nasopharyngeal aspirates of 2669 patients were collected. One-step real time PCR for detection of influenza virus was done according to the Centers for Disease Control and Prevention (CDC) protocol. Results: Influenza positivity was 15.8 per cent (423/2669) in symptomatic patients. Of the 423 total positives, 192 (7.2%) were influenza A and 231 (8.7%) were influenza B. Positivity for influenza virus was significantly (P=0.001, OR=2.9, CI=1.9-4.3) higher in patients with Influenza like illness (ILI) (17.4%, 396/2271) than those with severe acute respiratory illness (SARI) (6.8%, 27/398). Influenza A positive samples were subtyped as; pdmH1N1 (67.2%, 129/192) and seasonal H3N2 (32.8%, 63/192). It significantly correlated with monthly mean rainfall, humidity and dew point while atmospheric pressure was inversely related. No significant association was found with temperature and wind speed. Clinical variations were observed between different strains of Influenza virus. Interpretation & conclusions: The findings provide a clear picture of different clinical presentations of various strains of influenza A and B viruses and epidemiology of influenza infection from Lucknow (UP), India. The seasonality of influenza virus infection showed variation in relation to different environmental factors. Pandemic H1N1 caused more systemic infection than seasonal influenza A/H3N2 virus.

Viral aetiology of acute lower respiratory tract illness in hospitalised paediatric patients of a tertiary hospital: One year prospective study.

Context: Acute lower respiratory tract infections (ALRI), ranked as the second leading cause of death are the primary cause of hospitalisation in children. Viruses are the most important causative agents of ALRI. Aim: To study the viral aetiology of ALRI in children at a tertiary care hospital. Setting and Design: One year prospective observational study in a tertiary care hospital of King George’s Medical University, Lucknow. Material and Methods: Nasopharyngeal aspirate (NPA) was collected from children admitted with signs and symptoms of ALRI who were aged 0-14 years. Samples were transported to the laboratory at 4°C in viral transport media and processed for detection of respiratory syncytial virus (RSV) A and B, infl uenza virus A and B, adenovirus (ADV), human Boca virus (HBoV), human metapneumo virus (hMPV) and parainfl uenzavirus 1, 2, 3 and 4 using mono/multiplex real-time polymerase chain reaction (RT-PCR). STATA was used for statistical analysis. Results: In one year, 188 NPAs were screened for respiratory viruses, of which 45.7% tested positive. RSV was most commonly detected with 21.3% positivity followed by measles virus (8.5%), infl uenza A virus (7.4%), ADV (5.3%), infl uenza B virus (1.6%), hMPV (1.1%) and HBoV (0.5%). Month wise maximum positivity was seen in December and January. Positivity rate of RSV was highest in children aged < 1 year, which decreased with increase in age, while positive rate of infl uenza virus increased with increasing age. Conclusion: The occurrence of viral predominance in ALRI is highlighted.

Prevalence of hepatitis A virus, hepatitis B virus, hepatitis C virus, hepatitis D virus and hepatitis E virus as causes of acute viral hepatitis in North India: A hospital based study.

Context: Acute viral hepatitis (AVH) is a major public health problem and is an important cause of morbidity and mortality. Aim: The aim of the present study is to determine the prevalence of hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HEV) as causes of AVH in a tertiary care hospital of North India. Settings and Design: Blood samples and clinical information was collected from cases of AVH referred to the Grade I viral diagnostic laboratory over a 1-year period. Subjects and Methods: Samples were tested for hepatitis B surface antigen, anti-HCV total antibodies, anti-HAV immunoglobulin M (IgM) and anti-HEV IgM by the enzyme-linked immunosorbent assay. PCR for nucleic acid detection of HBV and HCV was also carried out. Those positive for HBV infection were tested for anti-HDV antibodies. Statistical Analysis Used: Fisher's exact test was used and a P < 0.05 was considered to be statistically significant. Results: Of the 267 viral hepatitis cases, 62 (23.22%) patients presented as acute hepatic failure. HAV (26.96%) was identified as the most common cause of acute hepatitis followed by HEV (17.97%), HBV (16.10%) and HCV (11.98%). Co-infections with more than one virus were present in 34 cases; HAV-HEV co-infection being the most common. HEV was the most important cause of acute hepatic failure followed by co-infection with HAV and HEV. An indication towards epidemiological shift of HAV infection from children to adults with a rise in HAV prevalence was seen. Conclusions: To the best of our knowledge, this is the first report indicating epidemiological shift of HAV in Uttar Pradesh.

Trend of dengue virus infection at Lucknow, north India (2008- 2010): A hospital based study.

Background & objectives: Dengue virus (DV) infection has emerged as a major health problem in north India. Here, we report the annual trend of dengue virus infection as seen in Lucknow, Uttar Pradesh, during 2008-2010. Methods: Blood samples from clinically suspected cases of dengue virus infection were collected and history was taken on structured clinical data sheet. All samples were tested for dengue IgM by antibody capture ELISA. Selected samples were tested by conventional RT-PCR for dengue virus RNA. Weather information was continuously recorded from website of world weather information service. Results: There was a gradual increase in number of dengue fever cases with increased occurrence in 2010. Cases referred in January - December 2008 were 398 (54.5% anti DV IgM positive), in January - December 2009 were 599 (51.9% anti DV IgM positive) and in January - December 2010 were 1602 (64.9% anti DV IgM positive). Serotypes circulating in years 2008, 2009 and 2010 were DV-2 & DV-3, DV -1, 2 & 3 and DV-1 and DV-2 respectively. There is no statistical significant correlation between weather data and increasing dengue positive cases. Interpretation & conclusions: Increased cases of dengue fever were seen in 2010, which was not correlated with any change in environmental factors. A change in circulating serotypes was noted.

Effect of yoga practices on pulmonary function tests including transfer factor of lung for carbon monoxide (TLCO) in asthma patients.

Prana is the energy, when the self-energizing force embraces the body with extension and expansion and control, it is pranayama. It may affect the milieu at the bronchioles and the alveoli particularly at the alveolo-capillary membrane to facilitate diffusion and transport of gases. It may also increase oxygenation at tissue level. Aim of our study is to compare pulmonary functions and diffusion capacity in patients of bronchial asthma before and after yogic intervention of 2 months. Sixty stable asthmatic-patients were randomized into two groups i.e group 1 (Yoga training group) and group 2 (control group). Each group included thirty patients. Lung functions were recorded on all patients at baseline, and then after two months. Group 1 subjects showed a statistically significant improvement (P<0.001) in Transfer factor of the lung for carbon monoxide (TLCO), forced vital capacity (FVC), forced expiratory volume in 1st sec (FEV1), peak expiratory flow rate (PEFR), maximum voluntary ventilation (MVV) and slow vital capacity (SVC) after yoga practice. Quality of life also increased significantly. It was concluded that pranayama & yoga breathing and stretching postures are used to increase respiratory stamina, relax the chest muscles, expand the lungs, raise energy levels, and calm the body.

Intravenous device associated blood stream staphylococcal infection in paediatric patients.

Background & objectives: Intravenous device (IVD) associated nosocomial blood stream infections due to staphylococci are major cause of morbidity and mortality. The present study was carried out to assess the frequency of staphylococcal IVD associated infections in a paediatric ward of a tertiary case hospital. Prevalence of resistance to commonly used antimicrobials in hospital acquired staphylococcal isolates was also tested. Methods: Children admitted in paediatric wards with IVD for more than 48 h were enrolled. Blood, IVD tip at the time of removal, skin swab at the site of insertion of IVD and nasal swab were collected and cultured by standard protocol. All staphylococcal isolates from any source were analyzed for antimicrobial susceptibility by disk diffusion method. Genotyping matching of those staphylococcal isolates was done which were isolated from different sites of the same patient, but were phonotypically similar. Genotype of blood isolate was compared with genotype of isolate from nose/IVD/skin. Results: Staphylococcus aureus was the most frequent blood isolate (8.7%) followed by Candida (2.9%), coagulase negative staphylococci (CoNS 2.6%), Pseudomonas spp. (0.4%), Klebsiella spp. (0.3%) and Escherichia coli (0.1%). Isolation of microorganisms from blood was significantly higher in patients whose skin, IVD and nose were colonized by same microorganism (P<0.001). None of the staphylococcal isolate was found to be resistant to glycopeptides (vancomycin and teicoplanin). High penicillin and oxacillin resistance was present in both S. aureus (penicillin resistance; 76.8%, oxacillin resistance; 66.7%) and CoNS (penicillin resistance; 73.3%, oxacillin resistance; 60.0%). Among CoNS biotypes, S. haemolyticus was commonest blood isolate while S. epidermidis was commonest isolate from Skin/nose. Only 33.3 per cent of S. aureus blood stream infections and most of S. epidermidis and S. haemolyticus blood infections were IVD associated. Interpretation & conclusions: Staphylococci were the major causative agent of nosocomial blood stream infections. All episodes of septicaemia due to S. epidermidis and S. haemolyticus were IVD associated while only 1/3 of S. aureus septicaemia was IVD associated.

Evaluation of antibacterial activities of chenopodium album L.

The present study was aimed to evaluate the antibacterial activities of Chenopodium album L. against five human pathogenic bacteria. Cheopodium album L. is belonging to family Chenopodiaceae and commonly known as Bathua. The collected leaves were washed, dried and powdered. Aqueous and methanol extracts were prepared and observed their antibacterial activity against human pathogenic bacteria Viz. Escherichia coli, Salmonella typhimurium, Staphylococcus aureus, Proteus vulgaris and Pseudomonas aueruginosa The significant results were obtained by aqueous as well as methanol leaf extract on tested pathogens using paper disc diffusion method. The aqueous extract revealed strongest antibacterial activity on Staphylococcus aureus and methanol leaf extract showed strongest antibacterial activity on Pseudomonas aeruginosa.

Identification, Characterization and Antibiotic Susceptibility Pattern of Non Fermenters from Clinical Specimens in Lucknow, Uttar Pradesh.

Present study was an attempt to study the prevalence of nonfermenter and its antibiotic susceptibility pattern at CSM Medical University, Lucknow. All the isolates and samples were selected from clinical specimens received in Bacteriology section, P.G. Depart of Microbiology, for culture. The observation were made on the nonfermenter isolates that can be isolated from clinical specimen using simple Laboratory media e.g. Blood Agar & Mac Conkey agar. All relevant history & information were recorded from the subjects. A total of 8340 specimen were screened for a period of one year. The prevalence of nonfermenters came to be 19.09% among all isolates. Most of spp. belongs to oxidase+ve group (77%). P. aeruginosa was found to be most common isolate (53%). Overall sensitivity profile for ciprofloxacin was 60%, P/T 58% & Amikacin 56%. Sensitivity of imepenem was 60% for multi-resistant isolates. The most resistant isolate was Sachrolytic Acinetobacter spp. The knowledge of synergism between drugs in context to different isolates may aid in effective therapy for these isolates.

Effect of pranayama & yoga-asana on cognitive brain functions in type 2 diabetes-P3 event related evoked potential (ERP).

Background & objectives: Electrophysiological evidence of delayed cognition as measured by P300, an evoked potential is observed in Diabetes mellitus. P300 (or P3) is a component of endogenous cerebral evoked response that assesses higher functions of the brain. Our study aims to see the role of pranayama and yoga-asana on P300 latency and amplitude in type 2 diabetic patients. Methods: Sixty patients of type 2 diabetes were recruited from diabetic clinic and divided into two groups - control group on only conventional medical therapy and yoga-group on conventional medical therapy along with pranayama and yoga-asana. Basal recordings of P300 and blood glucose were taken at the time of recruitment and second recordings repeated after forty five days for both the groups. P300 was recorded on Nihon Kohden Neuropack μ MEB 9100 using auditory “odd-ball paradigm”. The data were analysed using repeated measures analysis of variance (ANOVA) followed by Tukey’s test at 5 per cent level of significance. Results: Statistically significant improvement in the latency and the amplitude of N200, P300 was observed in the yoga group as compared to the control group. Interpretation & conclusions: Our data suggest that yoga has a beneficial effect on P300 and thus can be incorporated along with the conventional medical therapy for improving cognitive brain functions in diabetes.

Effect of yoga on pulmonary function tests of hypothyroid patients.

Aim of this study was to see any effect on respiratory functions in hypothyroid patients after pranayama (yoga). The subjects for the study were 20 hypothyroid females, 39.70±8.27 years of mean age referred from medicine department of UCMS & G.T.B. Hospital. Spiro metric recordings were taken with hypair (version-1.28). Baseline (first) recordings were taken when patient came for the first time. Patients came to yoga lab in physiology department for 21 days continuously where they were trained by the yoga instructors and then told to do pranayama at home and called at regular intervals after 7 days to see the compliance. The breathing exercises were done for 45 minutes everyday. After 6 months of pranayama second recording was taken and compared with the baseline. There were significant improvement in forced expiratory volume in first second (FEV1), Maximum voluntary ventilation (MVV) and Inspiratory Capacity(IC). Thus Pranayama and meditation has beneficial effect on pulmonary functions of hypothyroid patients along with conventional treatment.

Severe primary antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is characterised by recurrent venous or arterial thrombosis and/or fetal losses. In APS, the homeostatic regulation of blood coagulation is altered, however, the mechanism of thrombosis is not yet defined and it has varied manifestations. Deep vein thrombosis with or without pulmonary embolism is the most common manifestation followed by arterial occlusion of cerebral, coronary and other arteries including subclavian, retinal, renal and pedal arteries. We report a case of a 42 years old female, with severe primary APS, who presented with symmetrical peripheral gangrene, an uncommon presentation and was treated successfully.

Abnormal anther development and high sporopollenin synthesis in benzotriazole treated male sterile Helianthus annuus L.

Foliar application of 1.5% benzotriazole induced 100% pollen sterility in H. annuus. Pollen abortion in treated plants was mainly associated with abnormal behaviour of tapetum. A limited number of anther locule showed early degeneration of tapetum followed by disintegration of sporogenous tissues. On the other hand, some locules showed normal development of tapetum at initial stages. However, this tapetum exhibited degenerated and non-functional cell organelles. In both these situations tapetum failed to provide proper nourishment to developing microspores. The ultrastructure of both tapetum and microspores is different from that of control material with irregularities of exine deposition, endopolyploidy of tapetal nuclei and an alteration of organelle composition being correlated with sterility. Pollen grains thus developed were devoid of nucleus and cell organelles and were complete sterile.

Evaluation of the efficacy, safety and tolerability of miglitol in adult Indian patients with uncomplicated type 2 diabetes mellitus.

Postprandial hyperglycaemia and spikes have deleterious effects on Insulin secretion and sensitivity. The present study was undertaken to evaluate the efficacy, safety and tolerability of miglitol 50 mg three times daily for 12 weeks in 129 patients with type 2 diabetes mellitus, inadequately managed with diet and exercise therapy alone for 3 months after obtaining their written informed consent. The primary efficacy variables were per cent change from baseline at week 12 in fasting and postprandial plasma glucose concentrations and glycosylated haemoglobin (HbA(1C)) levels. After treatment at the end of 12 weeks mean reduction in fasting plasma glucose levels was 35.7% and 44.33% in postprandial plasma glucose levels while the mean HbA(1C) was significantly reduced by 0.88% (p<0.05). Total cholesterol, HDL, LDL and TC/HDL ratio did not showed any significant change but a non-significant reduction in triglyceride levels was observed in some patients. The mean body mass index was reduced non-significantly by 8% from baseline values. A total 19.5% patients treated with miglitol reported adverse events like flatulence, abdominal pain, nausea/vomiting, diarrhoea and dyspepsia. Only one patient reported hypoglycaemia. The results of the present study indicate that miglitol reduces fasting and postprandial plasma glucose levels, Improving glycaemic control, which is reflected in a reduced HbA(1C) level in patients with type 2 diabetes mellitus. It could be a useful first-line therapy in patients with type 2 diabetes mellitus inadequately controlled by diet alone and as adjuvant therapy in patients who are inadequately controlled with diet and sulfonylureas.

Effect of undernutrition and subsequent rehabilitation on brain 5-HT (serotonin) profile of developing newborn rats.

For littermate comparison, undernutrition in half of the pups of a litter was induced by 12h maternal deprivation from day 5 to day 18 postnatal. Subsequently, undernourished suckling rats were rehabilitated. Brain 5-HT concentrations and its turnover rate were measured on different days of age up to the period of 3 months. Brain 5-HT concentration was approximately half of the adult level at birth and increased progressively, except with a steep fall on day 18 postnatal, to the adult level by day 25 postnatal and thereafter it did not vary much on different days of age. Undernourished newborn rats showed significantly low level of brain 5-HT on day 9 and significantly higher concentrations on day 12 and 18 postnatal, whereas, rehabilitated rats showed comparable brain 5-HT concentrations with that of their nourished littermates. It is concluded that undernutrition had affected the brain 5-HT concentration and its turnover rate. Brain 5-HT concentration was low during early phase and was more during late phase of undernutrition. Rehabilitation of undernourished rats restored the brain 5-HT concentration similar to that of their nourished littermates.

Role of yoga in modifying certain cardiovascular functions in type 2 diabetic patients.

OBJECTIVES: 1. To study the effect of forty days of Yogic exercises on cardiac functions in Type 2 Diabetics. 2. To study the effect of forty days of Yogic exercises on blood glucose level, glycosylated hemoglobin. METHODS: The present study done in twenty-four Type 2 DM cases provides metabolic and clinical evidence of improvement in glycaemic control and autonomic functions. These middle-aged subjects were type II diabetics on antihyperglycaemic and dietary regimen. Their baseline fasting and postprandial blood glucose and glycosylated Hb were monitored along with autonomic function studies. The expert gave these patients training in yoga asanas and they pursued those 30-40 min/day for 40 days under guidance. These asanas consisted of 13 well known postures, done in a sequence. After 40 days of yoga asanas regimen, the parameters were repeated. RESULTS: The results indicate that there was significant decrease in fasting blood glucose levels from basal 190.08 +/- 18.54 in mg/dl to 141.5 +/- 16.3 in mg/dl after yoga regimen. The post prandial blood glucose levels decreased from 276.54 +/- 20.62 in mg/dl to 201.75 +/- 21.24 in mg/dl, glycosylated hemoglobin showed a decrease from 9.03 +/- 0.29% to 7.83 +/- 0.53% after yoga regimen. The pulse rate, systolic and diastolic blood pressure decreased significantly (from 86.45 +/- 2.0 to 77.65 +/- 2.5 pulse/min, from 142.0 +/- 3.9 to 126.0 +/- 3.2 mm of Hg and from 86.7 +/- 2.5 mm of Hg to 75.5 +/- 2.1 mm of Hg after yoga regimen respectively). Corrected QT interval (QTc) decreased from 0.42 +/- 0.0 to 0.40 +/- 0.0. CONCLUSION: These findings suggest that better glycaemic control and stable autonomic functions can be obtained in Type 2 DM cases with yoga asanas and pranayama. The exact mechanism as to how these postures and controlled breathing interact with somato-neuro-endocrine mechanism affecting metabolic and autonomic functions remains to be worked out.