Marine actinomycete Streptomyces variabilis S26 as a biocontrol agent for vibriosis in shrimp larval rearing systems.

Indiscriminate use of antibiotics has led to the emergence of antibiotic-resistant microbes and the loss of natural flora in aquaculture systems necessitating the ban of many of these chemotherapeutants in aquaculture. Actinobacteria play a profound role in the biogeochemical cycling in the marine environment and represent the principal source of secondary metabolites with antimicrobial property. In the present study, 98 marine-derived actinomycete isolates were screened for antimicrobial activity against the common aquatic pathogens. A potent actinomycete isolate S26, identified as Streptomyces variabilis based on 16 S ribosomal RNA (rRNA) gene sequencing was then checked for the production of antibiotic in five different fermentation media and the one which showed maximum production was chosen for further study. Optimization of the fermentation medium for secondary metabolite production was carried out by response surface methodology (RSM) using DESIGN EXPERT. The analysis of variance (ANOVA) of the quadratic regression model demonstrated that the model was highly significant for the response concerned that is, antimicrobial activity as evident from the Fisher's F- test with a very low probability value [(P model>F) = 0.0001]. Of the 10 different solutions suggested by the software, the most suitable composition was found to be starch, 1.38%; soy powder, 0.88%; ammonium sulfate, 0.16% and salinity, 27.76‰. S. variabilis S26 cultured in the optimized production medium was applied in the Penaeus monodon larval rearing system and the total Vibrio count and survival rate were estimated. S. variabilis S26 treatment showed a significant reduction in vibrios and conferred better protection to P. monodon in culture system compared with control.

Efficacy of Submucosal Diathermy of Inferior Turbinate in Patients with Chronic Rhinosinusitis Undergoing Functional Endoscopic Sinus Surgery.

Aim: To assess the efficacy of submucosal diathermy (SMD) in Chronic rhinosinusitis and inferior turbinate hypertrophy undergoing Functional Endoscopic Sinus Surgery. Materials and Methods: We conducted a Randomized Prospective study in patients undergoing Functional Endoscopic Sinus surgery for Chronic Rhinosinusitis in a tertiary care centre in South India for a period of 2 years. Patients were divided into two groups, Group A underwent FESS and Group B underwent FESS with SMD. The outcome was evaluated using nasal endoscopy score (NES), modified SNOT score and Modified Lund Kennedy scores. Results: A total of 80 patients were included in this study.40 patients were allotted in each group. Male: Female ratio was 48:32. The age distribution ranged from 19 to 44 years with a mean of 29.55 ± 6.90 yrs. Mean NES scores, Modified SNOT and Modified Lund -kennedy scores were estimated pre-operatively and during 1st, 2nd and 3rd month of post-operative periods. The mean pre-operative sores were comparable in both the groups except NES score, which was higher in group B. Both the groups showed significant improvement in post-operative period. Inter group comparison showed significant difference in all scores with group B having better results when compared to group A. Conclusion: This study proves that FESS combined with SMD improves the postoperative clinical outcomes when compared with FESS without turbinate reduction. We conclude that SMD is a simple, mucosal preserving technique with almost no complications and can be safely done along with FESS to improve the outcomes .

Endoscopic versus laparoscopic drainage of pseudocyst and walled-off necrosis following acute pancreatitis: a randomized trial.

BACKGROUND: Pancreatic fluid collections (PFC) may develop following acute pancreatitis (AP). Endoscopic and laparoscopic internal drainage are accepted modalities for drainage of PFCs but have not been compared in a randomized trial. Our objective was to compare endoscopic and laparoscopic internal drainage of pseudocyst/walled-off necrosis following AP. PATIENTS AND METHODS: Patients with symptomatic pseudocysts or walled-off necrosis suitable for laparoscopic and endoscopic transmural internal drainage were randomized to either modality in a randomized controlled trial. Endoscopic drainage comprised of per-oral transluminal cystogastrostomy. Additionally, endoscopic lavage and necrosectomy were done following a step-up approach for infected collections. Surgical laparoscopic cystogastrostomy was done for drainage, lavage, and necrosectomy. Primary outcome was resolution of PFCs by the intended modality and secondary outcome was complications. RESULTS: Sixty patients were randomized, 30 each to laparoscopic and endoscopic drainage. Both groups were comparable for baseline characteristics. The initial success rate was 83.3% in the laparoscopic and 76.6% in the endoscopic group (p = 0.7) after the index intervention. The overall success rate of 93.3% (28/30) and 90% (27/30) in the laparoscopic and endoscopic groups respectively was also similar (p = 1.0). Two patients in the laparoscopic group required endoscopic cystogastrostomy for persistent collections. Similarly, two patients in the endoscopic group required laparoscopic drainage. Postoperative complications were comparable between the groups except for higher post-procedure infection in the endoscopic group (19 vs. 9; p = 0.01) requiring endoscopic re-intervention. CONCLUSIONS: Endoscopic and laparoscopic techniques have similar efficacy for internal drainage of suitable pancreatic fluid collections with < 30% debris. The choice of procedure should depend on available expertise and patient preference.

Marine actinomycetes as bioremediators in Penaeus monodon rearing system.

Actinomycetes (277 Nos) isolated from marine environment and shrimp culture pond sediments were tested for hydrolytic enzyme production and biogranulation property. Potential isolates were screened for their efficacy in bioremediation of shrimp culture system. Based on the BOD reduction efficiency and water quality parameters, five actinomycete isolates viz., Streptomyces coelicoflavus (A6), Streptomyces diastaticus (A44), Nocardiopsis alba (A55), Streptomyces parvus (A56) and Streptomyces champavatii (R32) were subjected for tertiary screening in Penaeus monodon larval rearing system and the animals were challenged with white spot syndrome virus (WSSV). The bioremediating effect of actinomycete treatments were assessed by analysing the expression profile of five antimicrobial peptide (AMP) genes viz., anti-lipopolysaccharide factor (ALF), crustin-2, crustin-3, penaeidin-3 and penaeidin-5 and eight immune genes viz., alpha-2-macroglobulin (α-2-M), astakine, glutathione-S-transferase, haemocyanin, peroxinectin, pmCathepsinC, prophenol oxidase (proPO) and Rab-7. Expression of eight WSSV genes viz., DNA polymerase, endonuclease, protein kinase, immediate early gene, latency related gene, ribonucleotide reductase, thymidine kinase and VP28 were also analyzed to detect the presence and intensity of viral infection in the experimental animals post-challenge. Theapplication of consortia (1 g/5 L water) yields better results in terms of significant reduction in BOD of shrimp rearing system showing the bioremediation potential of the marine actinomycete strains. The application of marine actinomycetes viz., Streptomyces coelicoflavus (A6), Streptomyces diastaticus (A44), Nocardiopsis alba (A55), Streptomyces parvus (A56) and Streptomyces champavatii (R32) in granulated form were found to be potential bioremediators in shrimp rearing system.

A prospective randomised controlled trial comparing chronic groin pain and quality of life in lightweight versus heavyweight polypropylene mesh in laparoscopic inguinal hernia repair.

BACKGROUND: The aim of our study was to compare chronic groin pain and quality of life (QOL) after laparoscopic lightweight (LW) and heavyweight (HW) mesh repair for groin hernia. MATERIALS AND METHODS: One hundred and forty adult patients with uncomplicated inguinal hernia were randomised into HW mesh group or LW mesh group. Return to activity, chronic groin pain and recurrence rates were assessed. Short form-36 v2 health survey was used for QOL analysis. RESULTS: One hundred and thirty-one completed follow-up of 3 months, 66 in HW mesh group and 65 in LW mesh group. Early post-operative convalescence was better in LW mesh group in terms of early return to walking (P = 0.01) and driving (P = 0.05). The incidence of early post-operative pain, chronic groin pain and QOL and recurrences were comparable. CONCLUSION: Outcomes following laparoscopic inguinal hernia repair using HW and LW mesh are comparable in the short-term as well as long-term.

Factors Affecting Short-Term and Long-Term Outcomes After Bilioenteric Reconstruction for Post-cholecystectomy Bile Duct Injury: Experience at a Tertiary Care Centre.

Bile duct injury following cholecystectomy is an iatrogenic catastrophe associated with significant perioperative morbidity, reduced long-term survival and quality of life. There has been little literature on the long-term outcomes after surgical reconstruction and factors affecting it. The aim of this study was to study factors affecting long-term outcomes following surgical repair of iatrogenic bile duct injury being referred to a tertiary care centre. Between January 2005 to December 2011, 138 patients with bile duct injury were treated in a single surgical unit in a tertiary care referral hospital. Preoperative details were recorded. After initial resuscitation, any intra-abdominal collection was drained and an imaging of biliary anatomy was done. Once the general condition of the patient improved, patients were taken up for a side-to-side extended left duct hepaticojejunostomy. The post-operative outcomes were recorded and a hepatobiliary iminodiacetic acid scan and liver function tests were done, and then the patients were followed up at regular intervals. Clinical outcome was evaluated according to clinical grades described by Terblanche and Worthley (Surgery 108:828-834, 1990). The variables were compared using chi-square, unpaired Student's t test and Fisher's exact test. A two-tailed p value of <0.05 was considered significant. One hundred thirty-eight patients, 106 (76.8 %) females and 32 (23.2 %) males with an age range of 20-63 years (median 40.8 ± SD) with bile duct injury following open or laparoscopic cholecystectomy, were operated during this period. Majority of the patients [83 (60.1 %)] had a delayed presentation of more than 3 months. Based on imaging, Strasburg type E1 was seen in 17 (12.5 %), type E2 in 30 (21.7 %), type E3 in 85 (61.5 %) and type E4 in 6 (4.3 %). On multivariate analysis, only level of injury, longer duration of referral and associated vascular injury were independently associated with an overall poor long-term outcome. This study demonstrates level of injury at or above the confluence; associated vascular injury and delay in referral were associated with poorer outcomes in long-term follow-up; however, almost all patients had excellent outcome in long-term follow-up.

A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair.

BACKGROUND: Data are insufficient to compare transabdominal preperitoneal repair (TAPP) and total extraperitoneal (TEP) techniques of laparoscopic inguinal hernia repair. There is very scant data comparing the two techniques in terms of long-term outcomes, which include chronic groin pain, quality of life, and time to return to normal activity. This prospective, randomized, controlled trial compared TEP versus TAPP techniques of laparoscopic inguinal hernia repair in terms of these long-term outcomes. METHODS: This study was conducted from May 1, 2007 to March 30, 2012. Patients with uncomplicated groin hernia were randomized to transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) techniques. A total of 160 patients were randomized to group I (TEP) and 154 patients to group II (TAPP). Pain was assessed with Visual Analogue Scale (VAS) preoperatively and postoperatively at 24 h, 1 week, 6 weeks, 3, 6, and 12 months, and yearly thereafter. Quality of life was assessed with Short Form-36 version 2 (SF 36v2) preoperatively and postoperatively at 3 months follow-up. RESULTS: Demographic, clinical profiles, intraoperative, and early postoperative parameters were well matched. There was significantly higher acute pain following TAPP repair; however, the chronic groin pain was comparable in both TEP and TAPP. Preoperative pain and immediate postoperative pain had significant correlation with chronic groin pain. Significant improvement from preoperative to postoperative quality of life was seen in both TEP and TAPP repairs, but there was no difference between TEP and TAPP in postoperative period. Time to return to normal activity also was similar between the two groups. CONCLUSIONS: The TEP and TAPP techniques of laparoscopic repair of inguinal hernia have comparable long-term outcomes in terms of incidence of chronic groin pain, quality of life, and resumption of normal activities. Chronic groin pain had a significant correlation with preoperative pain and early postoperative pain. However, TAPP was associated with significantly higher incidence of early postoperative pain, longer operative time, and cord edema, whereas TEP was associated with a significant higher incidence of seroma formation. The cost was comparable between the two.

Marine yeast Candida aquaetextoris S527 as a potential immunostimulant in black tiger shrimp Penaeus monodon.

A marine yeast Candida aquaetextoris S527 as a source of immunostimulant in Penaeus monodon was studied. Yeast diet was prepared by incorporating 10% C. aquaetextoris S527 biomass into a standard shrimp diet and administered in P. monodon at different frequencies (daily, once in three days, once in seven days and once in ten days) followed by challenge with white spot syndrome virus (WSSV). Immune parameters such as total protein, total hemocyte count, pro-phenoloxidase, nitroblue tetrazolium reduction, alkaline phosphatase activity and acid phosphatase activity were tested. Expression profile of antimicrobial peptide (AMP) genes viz., anti-lipopolysaccharide factor (ALF), crustin-1, crustin-2, crustin-3, penaeidin-3 and penaeidin-5; immune genes viz., alpha-2-macroglobulin (α-2-M), astakine, peroxinectin, prophenol oxidase (proPO) and transglutaminase, and WSSV genes viz., DNA polymerase, endonuclease, protein kinase, immediate early gene, latency related gene, ribonucleotide reductase, thymidine kinase and VP28 were analyzed. The study demonstrated that marine yeast diet administered once every seven days conferred better protection to P. monodon against WSSV infection, supported by the hematological and immune gene expression profiles analyzed.

Comparison of long-term outcome and quality of life after laparoscopic repair of incisional and ventral hernias with suture fixation with and without tacks: a prospective, randomized, controlled study.

BACKGROUND: Technique of mesh fixation in laparoscopic incisional hernia repair is a matter of debate. Literature is lacking in randomized trials comparing various methods of mesh fixation. This study was designed to compare the cost-effectiveness and long-term outcomes following the two methods of mesh fixation. METHODS: A total of 110 patients were randomized to tacker mesh fixation or suture mesh fixation. Patients with nonrecurrent hernias with defect size ranging from 2 to 5 cm were included. The cost and incremental cost-effectiveness ratio was calculated. SF-36v2 health survey was used for quality-of-life analysis. Patients were followed up at regular intervals, and return to activity and satisfaction scores were recorded. RESULTS: Demographic profile and hernia characteristics were comparable between the two groups. Operation time was significantly higher (p < 0) and early postoperative pain at 1 h, 6 h, and 1 month was significantly lower in the suture group. There was no significant difference in the incidence of chronic pain and seroma formation over a mean follow-up of 32.2 months. Cost of procedure was significantly higher in group I (p < 0.001). Suture fixation was found to be more cost-effective than tacker fixation. Postoperative quality of life outcomes were similar in the two groups. Among return to activity parameters, time to resumption of daily activities and starting climbing stairs were significantly shorter in the suture group. CONCLUSIONS: The suture fixation method is a cost-effective alternative to tacker fixation in patients with small- to medium-sized defects in laparoscopic incisional and ventral hernia repair. Suture fixation is better than tacker fixation in terms of early postoperative pain and return to activity. The two procedures are equally effective regarding the recurrence rates, complications, hospital stay, chronic pain, quality of life determinants, and patient satisfaction.