Recommendations of apex health bodies remain localized: not in conformity with international implementation policy for urological disorders.

In developing/underdeveloped countries there is still a great burden of adverse drug reaction (ADR), morbidity and mortality because of poor regulations and implementation of preventive measures. These countries try to copy/follow guidelines from international bodies like American Urology Association (AUA), European Association of Urology (EAU), AGS, UMC and WHO irrespective of their country of origin and success in implementation. Although recommendations of these organizations are obligatory, yet these are taken as the gold standard for good clinical practices. This manuscript highlights difference in view point of various apex health organizations in formulating health policies for prevention, diagnosis, treatment and ADR monitoring for urological disorders. Lacking role of regulatory bodies in implementation of existing policies may lead to potentially inappropriate medication and produce a great economic burden. This analysis has prompted us to recommend that these apex bodies should have better coordination in producing a single value document, make it mandatory part of curricula in medical schools for better awareness, awareness campaigns and separate reporting column in ADR form.

Severity of thyroid eye disease and type-2 diabetes mellitus: Is there a correlation?

Purpose: To study the correlation between thyroid eye disease (TED) with type-2 diabetes mellitus. Methods: A cross-sectional cohort study was conducted from Jan 2018 to Dec 2018, in patients presenting with thyroid eye disease to orbit and oculoplasty clinic of a tertiary eye care hospital. A total of 105 patients were included in the study. All patients underwent detailed ophthalmic evaluation and thyroid eye disease workup. Patients were categorized into mild, moderate, and severe/sight-threatening TED based on EUGOGO classification. Systemic history of diabetes was noted. RBS was done in all patients. Results: Mild disease was noted 61 patients of which 11 were diabetics, moderate in 26 patients (8 diabetics), and severe disease in 18 patients (14 diabetics). All patients were treated accordingly. Among the TED patients, the percentage of diabetic patients was noted to be in increasing order toward the severity spectrum of TED. The prevalence of severe TED was found to be much higher in diabetic patients accounting upto 77.77% of 18 patients. A statistically significant correlation was noted (P = 0.014) between severe TED and type-2 diabetes mellitus. In addition, early onset of thyroid eye disease was noted in type-2 diabetes patients. Even though female preponderance was noted, severe TED was more in men (66.6%). Conclusion: An autoimmune etiology for the association of thyroid and type-1diabetes has been well established. This study shows that type-2 diabetic patients can have more severity in the clinical presentation of TED. Therefore, the presence of type-2 DM in patients with TED can be a predictive factor for onset, progression, and severity of disease. Hence, a high concern of interest among treating ophthalmologists and endocrinologists regarding this entity would help in early prediction and decreased morbidity among such patients.

Targeting miRNA for Therapeutics Using a Micronome Based Method for Identification of miRNA-mRNA Pairs and Validation of Key Regulator miRNA.

MicroRNAs are 18-22 bp long non-coding sequences and play a critical role in diverse biological processes, through modulation of gene expression at the post-transcriptional level by binding at the 3'-untranslated region of target mRNA. Consequent upon the discovery of structural and functional features of miRNA targeting, several molecular methods have been developed to identify miRNA targets. However, these methods suffer several drawbacks, including technical challenges, requirement of high cell volumes, inability to differentiate between direct and indirect targets, cell/tissue as well as experimental-specificity and imprecise binding site information. Alternatively in silico approach enables the exploration of the potential miRNA-mRNA pairs to investigate signature miRNA and proteins involved in the signaling of various diseases. Here, we describe micronome-based standard method for identification of miRNA-mRNA pairs as well as validation of key regulator miRNA.

Method for Detection of miRNAs in Non-Model Organisms with Unreported Database.

Non-model organisms are studied very frequently, as a simple accessible and convenient system to investigate the role of miRNAs in particular aspect of biology or disease. However, the unavailability of the annotated genome and hence miRNA database of these non-model organisms pose a major constraint for using them more efficiently. Here, we describe a new method to identify miRNAs in non-model organisms without complex sequencing strategies and using miRNAs from close relative organisms as proxy/reference sequences.

Antimicrobial resistance profile of Methicillin-resistant Staphylococcus aureus colonizing the anterior nares of health-care workers and outpatients attending the remotely located tertiary care hospital of North India.

INTRODUCTION: Resistance to antimicrobial agents is a major concern worldwide and is exemplified by the global spread of the Methicillin resistant Staphylococcus aureus (MRSA). Health care workers (HCWs) and asymptomatically colonized patients are important sources of nosocomial MRSA infections. AIMS AND OBJECTIVES: To determine the prevalence of MRSA colonisation, two hundred HCWs and 200 consecutive outpatients attending our tertiary care hospital were studied. MATERIAL AND METHODS: Two sterile pre-moistened cotton tipped swabs were used to collect specimens from their anterior nares. These were inoculated immediately on Blood agar with oxacillin, Mannitol salt agar with oxacillin and CHROM agar. Resistance to cefoxitin was confirmed by PCR by demonstration of mecA gene. Antibiotic susceptibility was determined by Kirby Bauer's disc diffusion method and MIC of vancomycin by using broth dilution and Vitek-2 Compact system. RESULTS: The nasal carriage of MRSA among HCWs was found to be 7.5% and in outpatients 3%. All strains of MRSA from HCWs and outpatients grew on three selective media and mecA gene amplified in all of them. All the isolated strains of MRSA showed high degree of resistance to co-trimoxazole (93.3%), ciprofloxacin (80%) and erythromycin (66.66%). However, there was 100% susceptiability to vancomycin, teicoplanin, linezolid and Rifampicin. CONCLUSION: Although a direct casual relationship could not be established, it could be assumed that the transmission from colonised health care worker is responsible atleast in part for MRSA infection among patients. Therefore emphasis should be laid on strict implementation of standard infection control practices which would help in minimizing the carriage and transmission of MRSA in the hospital.

Kitchen phytochemicals from Allium cepa - their role in multidrug resistance.

Bacterial resistance to antibiotics is increasingly becoming a concern to public health. Current antibiotics have failed to bring desirable results to many bacterial infections due to multi-resistant strains. So, concerted efforts are being made to curve this with the help of dietary phytohemicals. A number of dietary phytochemical are being put to trials for antimicrobial activity; however it is worthwhile to search such a part of diet that is very frequently used by major population. Keeping this view in mind an effort has been made to evaluate the antimicrobial activity of most common vegetable component Allium cepa. Methanolic and aqueous extracts were prepared from Allium cepa and antibacterial activity was tested on four pathogenic bacteria (Gram-positive and Gram negative) Staphylococcus aureus, Bacillus Subtilis, Escherichia coli and Pseudomonas aeruginosa using Disc diffusion method and Minimum inhibitory concentration by the Microtitre well plate method. Conventional antibiotic discs of Tetracycline and Gentamycin were used as positive control. Among the two extracts, methanolic extract exhibited a significant antimicrobial activity on the test organisms Ps. aeruginosa (17.5mm) and B. subtilis (11.3mm). The minimum inhibitory concentration value for Ps. aeruginosa was 500µl and for B. subtilis was 250µl for methanolic extract. The growth of other two bacteria i.e. E. coli and S. aureus were not inhibited by methanolic as well as aqueous extract that indicates non susceptibility to aqueous and methanol extract of Allium cepa. From the study, it was concluded that the commonly used Allium cepa possess potent antibacterial property against Bacillus Subtilis and Pseudomonas aeruginosa.

Cerebral Venous Sinus Thrombosis and Posterior Reversible Encephalopathy Syndrome Coexisting in a Woman: A Rare Coincidence.

Cerebral venous sinus thrombosis (CVST) and posterior reversible encephalopathy syndrome (PRES) are two rare diseases which may present with similar symptoms and signs. We report a case with coexisting PRES and CVST in a 34 years old postpartum female presented with multiple episodes of generalized seizures and bilateral vision loss after delivery. MRI brain and venography revealed left transverse sinus, sigmoid sinus and internal cerebral vein thrombosis with vasogenic edema in bilateral parieto-occipital, right temporal and left frontal area, which was suggestive of posterior reversible encephalopathy syndrome (PRES). She was treated with antihypertensive, low molecular weight heparin (LMWH), oral anticoagulant and responded well to the treatment.

Rapid Detection of Mycobacterium tuberculosis in Sputum Samples by Cepheid Xpert Assay: A Clinical Study.

BACKGROUND AND OBJECTIVE: Tuberculosis (TB) is one of the commonest opportunistic infection and the leading cause of death in HIV patients in developing countries. HIV infection is a well recognised risk factor for both activation of initial infection and reactivation of latent infection. This study was done to find out the co-prevalence and the trend of HIV infection among tuberculosis patients and to determine the prevalence of MDR Tuberculosis in HIV positive patients using Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA, United States). MATERIALS AND METHODS: The sputum samples are received from five districts of Punjab. Sputum samples of the patients with symptoms suggestive of pulmonary tuberculosis including both new cases and on treatment are received from the various district and civil hospitals of five districts. Sputum specimen was processed for TB detection by Cartridge Based Nucleic Acid Amplification testing (CB-NAAT) using Xpert MTB/RiF assay technology. RESULTS: The study period is from October 2013 to September 2014. A total of 907 patients with symptoms suggestive of pulmonary tuberculosis including both new cases and on treatment. Out of these patients 733 were reported MTB detected. Out of these 907 patients 29 were reported HIV positive and out of 733 patients 19(2.5%) were reported positive for (HIV +TUBERCULOSIS). Of these 19 cases 16(84.21%) cases were sensitive to rifampicin (RIF) and 3(15.78%) cases were showing resistance to rifampicin (RIF) Drug. CONCLUSION: Co-existence of HIV and tuberculosis is high and there is high Prevalence of MDR tuberculosis in HIV patients.

Hepatitis C Virus (HCV) Infection among Seronegative Patients undergoing Haemodialysis in a Remotely Located Tertiary Care Hospital of Northern India: Value of HCV-RNA and Genotypes.

BACKGROUND: Haemodialysis (HD) patients are at an increased risk of Hepatitis C virus (HCV) infection, which is significantly associated with increased morbidity and mortality. AIM: The aim of this study was to find the prevalence of HCV infection in anti-HCV antibody negative haemodialysis patients by Real-time PCR (RT-PCR) and value of HCV-RNA among seronegative patients undergoing haemodialysis in a remotely located tertiary care hospital. MATERIALS AND METHODS: A total of 100 chronic renal failure patients on haemodialysis were studied. All the patients were screened for anti-HCV antibodies by ELISA test and for HCV-RNA by RT-PCR. RESULTS: The overall prevalence of HCV infection was 32%. Antibody positivity was 30% and HCV-RNA by RT-PCR was detected in 20%. HCV-RNA in seronegative patients was detected in 2.8%. CONCLUSION: Serological assays (30%) are quite reliable for detecting HCV infection in patients undergoing haemodialysis in our tertiary care hospital. Only a small proportion of them (2.8%) require the documentation of viral genome for current infection.

Water borne hepatitis a and hepatitis e in malwa region of punjab, India.

INTRODUCTION: Hepatitis-A virus infection (HAV) and Hepatitis E virus infection (HEV) are faecally contaminated water borne infection of great public interest in developing countries. HAV has a world-wide /dablestribution and affects infant and young children in developing countries and its epidemics are not very common. HEV is restricted to tropical countries and affects older children and young adults and its epidemics are common. Studies suggested that HEV is etiologically responsible for 10%-95% of admitted cases of hepatitis. Exposure rates over a period of time are different in different parts of the country and in different socio-economic groups. Aim of the study 1. To study the prevalence of HAV and HEV in the outbreak of hepatitis in certain areas of Malwa region of Punjab, India. 2. To determine the age specific prevalence rates of HAV and HEV. 3. To determine any change in the epidemiology of these infections. MATERIAL AND METHODS: This study was conducted in the Department of Microbiology in GGMC and Hospital Faridkot, A leading Tertiary care hospital and the major referral centre of malwa region of Punjab,India. Collection and Serological Tests: 1.Venous blood samples of patients of acute hepatitis were taken. 2.Relavent information regarding their Age, Sex Education, Socio-economic status, personal and community hygiene were recorded. All of the sera were screened for IgM Antibody to HEV and HAV using IgM capture ELISA Kit (ASIA-LION Biotechnology for HEV and GENERAL BIOLOGICAL CORPORATION for HAV ) in accordance with the manufacturer's instructions. Result and Conclusion : 1.The outbreak was due to hepatitis A &E virus(HEV predominating resulting from fecal contamination of drinking water). 2.Hepatitis E is more widely prevalent 3.There is a change in the epidemiology of HAV so,more cases are seen in age group of more than 20 years.

In vitro evaluation of antimicrobial activity of Kutajghan vati - an Ayurvedic formulation.

The present investigation focuses to determine the antimicrobial potential of an Ayurvedic formulation Kutajghan vati. In this study the activity of this formulation was compared with the standard antibiotics like Amikacin and Norfloxacin. Ethanol, methanol and acetone extract of Kutajghan vati demonstrated good antimicrobial activity and thus can form the basis for the development of a novel antibacterial formulation.

Acquired Gitelman's syndrome: an oxymoron?

We present the case of a 27-year-old woman with end stage renal disease from Diabetes Mellitus type 1 who had been on hemodialysis for a year. Her father, who was otherwise healthy, was evaluated as a possible living donor. Incidentally, during the workup process, he was identified as having Gitelman's syndrome (GS). The transplant proceeded without any complications, following which the recipient developed biochemical abnormalities consistent with GS. Both donor and recipient are doing well at this time. To our knowledge, this is the only known case of kidney donation by a patient with GS either living or deceased.

Dysplasia and malignancy in endocervical polyps.

OBJECTIVE: The objective was to estimate the prevalence of malignancy or dysplasia in cervical polyps. METHODS: A convenience sample was identified by retrospectively searching the Hartford Hospital pathology database for cases of endocervical polyps removed from January 1, 1999, through January 31, 2006. The presence of malignancy, dysplasia, atypia, and other modifiers was recorded along with demographic information, including age, race/ethnicity, residence, and the ordering practitioner. RESULTS: The sample size consisted of 2246 polyps obtained from 2100 women, who ranged in age from 16 to 95 years (mean +/- SD, 48.6 +/- 10.9). The women were 82.4% white, 3.4% African American, 5.4% Hispanic, 0.4% Asian, and 8.3% other. The majority of women were from private practices (95.2%), and obstetrics/gynecology providers sent 98.3% of the polyp samples. Malignancy was diagnosed in 0.1% of cases. Polyps showed dysplasia in 0.5% of cases, and reactive atypia was seen in 1.6%. Inflammatory changes were seen in 27.7% of polyps, metaplasia in 13.6%, and microglandular hyperplasia in 6.8%. The recurrence rate was 6.2%. CONCLUSIONS: The prevalence of malignancy and dysplasia in cervical polyps removed over a 7-year span was 0.1% and 0.5%, respectively. Cervical polyps can harbor disease from sources beyond the cervix. Because there were no cases of primary malignancy in this large series of cervical polyps, it appears unlikely that cervical polyps progress to malignancy. Additionally, polyp recurrence is not uncommon. This information has significant implications as physicians plan appropriate counseling and management for the common diagnosis of cervical polyps.

Levamisole and Podophyllin For the Treatment of Condylomata Acuminata.

Levamisole, a wide spectrum antihelminthic has been compared for its, curative effect on condylomata acuminata with podophyhin when given alone or combind with podophylfin topically. A cure rate of83.6% was obtained with podophyllin alone after in average Of 1.6 applications. With combined therapy, comparable good, results- were. Obtained i.e. a cure rate of 79.0% after applications. Levamisole was found to tie completely disappointing and had no effect on warts either given alone or in combination with podophyllin. No serious local or system side effects were noted with podophyllin and levamisole. Perianal and intraameatal warts were found to be relatively resistant to therapy.