Phage therapy of staphylococcal chronic osteomyelitis in experimental animal model.

BACKGROUND & OBJECTIVES: Methicillin resistant Staphylococcus aureus (MRSA) are the commonest cause of osteomyelitis. The aim of this study was to evaluate the role of an alternative therapy i.e. application of S. aureus specific bacteriophages in cases of osteomyelitis caused by MRSA in animal model. METHODS: Twenty two rabbits were included in this study. The first two rabbits were used to test the safety of phage cocktail while the remaining 20 rabbits were divided into three groups; group A (n=4) to assess the establishment of osteomyelitis; group B (n=4) osteomyelitis developed but therapy started only after six weeks; and group C (n=12) osteomyelitis developed and therapy started after three weeks. Groups B and C rabbits were treated with four doses of cocktail of seven virulent bacteriophages at the interval of 48 h. Comparison between three groups was made on the basis of observation of clinical, radiological, microbiological, and histopathological examinations. RESULTS: Experimental group rabbits recovered from the illness in the subsequent two weeks of the therapy. Appetite and activity of the rabbits improved, local oedema, erythema and induration subsided. There were minimal changes associated with osteomyelitis in X-ray and histopathology also showed no signs of infection with new bone formation. Control B group rabbits also recovered well from the infection. INTERPRETATION & CONCLUSIONS: The present study shows a potential of phage therapy to treat difficult infections caused by multidrug resistant bacteria.

Association of Helicobacter pylori infection with inflammatory cytokine expression in patients with gallbladder cancer.

AIM: Gallbladder cancer (GBC) may be associated with Helicobacter pylori. The present study was designed to analyze the association of cytokine expression with H. pylori in patients with GBC. METHODS: GBC tissue sample and 5 mL blood were collected from each of 54 GBC patients. H. pylori was identified in tissue samples using biochemical tests, histology, culture, nested polymerase chain reaction (PCR), and partial genome sequencing. Tissue samples were categorized as H. pylori-positive (case) and H. pylori-negative groups (control) on the basis of nested PCR of tissue sample. Cytokines interleukin 1-ß (IL-1ß), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and interleukin-5 (IL-5) were assayed in blood samples using ELISA. RESULTS: Presence of H. pylori was confirmed in 18 (33 %) of 54 GBC tissue samples. Levels of IL-1ß (p = 0.001) and TNF-α (p = 0.01) were significantly elevated in H. pylori-positive GBC compared to the control group. IFN-γ and IL-5 levels did not significantly differ between the two groups. CONCLUSIONS: H. pylori DNA was detected in the gallbladder of a third of GBC patients and was associated with higher circulating levels of some cytokines.

Layered double hydroxide induced advancement in joint prosthesis using bone cement: the effect of metal substitution.

Poly(methyl methacrylate) based bone cement and its nanocomposites with layered double hydroxide (LDH) have been developed with greater mechanical strength and biocompatibility as a grouting material for total joint arthroplasty. Bivalent magnesium has been replaced with trivalent aluminium with various mole ratios, keeping the layered pattern of the LDH intact, to cater for the effect of varying substitution on the property enhancement of the nanocomposites. The intercalation of polymer inside the LDH layers makes them disordered and mechanically stiffer and tougher by more than 100%. The thermal stability of bone cement has increased by more than 30 °C in the presence of 1 wt% of nanoLDH, homogenously distributed in the bone cement matrix by creating an inorganic thermal barrier out of the LDH dispersion. The improvement in the properties of the nanocomposites has been explained in terms of the strong interaction between nanoLDH and polymer. The superior bioactivity and biocompatibility of the nanocomposites, as compared to pure bone cement, has been established through hemolysis assay, cell adhesion, MTT assay and cell proliferation using fluorescence imaging. The developed nanocomposites have been used as a grouting material and significant improvements have been achieved in fatigue behaviour with gradual increment of Al substitution in the Mg : Al mole ratio in nanoLDH, demonstrating the real use of the material in the biomedical area. In vivo experiments on rabbits clearly revealed the superior efficacy of bone cement nanocomposites, over pure bone cement and a blank.

Helicobacter species and pathogenesis of gallbladder cancer.

BACKGROUND: Gallbladder cancer (GBC) is a rare disease but a leading cause of cancer-related death worldwide. A number of etiological factors have been implicated in the causation of GBC and pathogenic infection by bacteria is one of these. DATA SOURCES: A PubMed search on "helicobacter", "gallbladder cancer", and "biliary tract malignancies" was done on the topic, and the relevant data were collected, reviewed, and analyzed. RESULTS: Helicobacter is an epsilon proteobacterium that infects the mucosal lining of the human gastrobiliary system. Infection with helicobacter is an important risk factor for the development of cancer and the bacterium has been categorized as a group-I carcinogen by the International Agency for Research on Cancer (IARC). These microbes enter the human body by means of contaminated food and water. Thereby they invade the tissues and produce chemical carcinogens that lead to DNA damage and subsequently a series of gene mutations transform normal cells into cancer cells. In this review, we focus our attention on the role of helicobacter in the causation of biliary tract malignancies. CONCLUSIONS: The review attempts to summarize the current available data on the role of helicobacter in the causation of GBC. There are accountable data available to suggest the role of helicobacter species in the causation of GBC although larger studies are urgently required for confirmation.

Gallbladder carcinoid masquerading as gallbladder carcinoma.

BACKGROUND: Carcinoid of the gallbladder is rare. Since it often presents as a gallbladder mass it may be confused with gallbladder carcinoma. METHODS: A 35-year-old lady presented with pain in the right upper abdomen, and was radiologically found to have a gallbladder mass. A provisional diagnosis of gallbladder carcinoma was made. Laparotomy revealed a 20 x 20 cm, exophytic, friable growth arising from the fundus of the gallbladder. It was excised with segment IVb and V of the liver and regional lymphadenectomy. RESULT: Histopathological examination revealed it was a neuroendocrine carcinoma, atypical carcinoid of the gallbladder. CONCLUSION: Gallbladder carcinoid has a poor outcome, requires aggressive treatment, and should be considered as one of the rare but possible gallbladder lesions.

Isolated tuberculosis of the ampulla of vater masquerading as periampullary carcinoma: a case report.

CONTEXT: Isolated tuberculosis of the ampulla of Vater has not yet been reported. The clinical features of isolated periampullary tuberculosis are at times similar to those seen in patients with periampullary carcinoma. Diagnosis is difficult, and biopsy and culture of the suspected lesion are often negative for Mycobacterium tuberculosis. CASE REPORT: We herein describe one such case masquerading as periampullary carcinoma in a 70-year-old woman. Due to comorbid conditions only a local excision of the ampulla was carried out. Histopathology revealed giant cells in the absence of caseation necrosis and the presence of Mycobacterium tuberculosis was proven using the polymerase chain reaction. CONCLUSION: Isolated tuberculosis of ampulla of Vater is extremely rare but must be kept in mind when making the differential diagnosis of isolated ampullary lesion.