Prevalence of biofilm producing aerobic bacterial isolates in burn wound infections at a tertiary care hospital in northern India.

Burn wounds frequently get infected due to a break in skin integrity and prolonged hospitalization. Microbial flora originating from the patient's own flora colonize and infect the burn wounds. Bacterial biofilms in particular are postulated as the culprit for the development of non-healing burn wounds by inducing chronic inflammation in these patients. In the present study, 190 wound isolates obtained from patients admitted to the burn ward at the Pt. B.D. Sharma PGIMS, Rohtak, were evaluated for biofilm formation along with Antimicrobial Susceptibility Testing (AST). Biofilm detection was done by modified Tissue Culture Plate method and AST was done by Kirby-Bauer disc diffusion method. A total of 190 isolates were studied, which included Staphylococcus aureus, Coagulase negative Staphylococcus, Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella spp., Proteus spp., Citrobacter spp., Escherichia coli and Enterobacter spp. Of these, 68.9% isolates showed biofilm formation. Biofilm formation was more common in Pseudomonas aeruginosa followed by Klebsiella spp. and Staphylococcus aureus. Biofilm producing isolates showed greater multidrug resistance than non-biofilm producers. In our study, a high rate of biofilm formation and antimicrobial drug resistance was seen.

Les zones brûlées sont fréquemment infectées, en raison de la lésion cutanée et de la longue durée d'hospitalisation. La colonisation et l'infection des zones brûlées sont le fait de la flore du patient. Le biofilm bactérien est suspecté responsable de l'absence de cicatrisation des brûlures, en raison de l'inflammation chronique qu'il entraîne. Dans cette étude, nous avons évalué, conjointement à leur antibiogramme, la capacité de formation de biofilm de 190 bactéries isolées chez des patients brûlés hospitalisés dans le service idoine de l'hôpital du Président Sharma PGIMS de Rothak. Les antibiogrammes étaient réalisées par méthode de diffusion en gélose, la recherche de formation de biofilm par culture tissulaire modifiée. Parmi les 190 bactéries isolées, on trouvait Staphylococcus aureus, SCN, Pseudomonas æruginosa, Acinetobacter baumannii, Klebsiella spp., Proteus spp., Citrobacter spp., Escherichia coli et Enterobacter spp. La production de biofilm, observée sur 68,9% des souches était plus fréquente par Pseudomonas æruginosa, suivi de Klebsiella spp. et de Staphylococcus aureus. Les bactéries productrices de biofilm s'avéraient plus résistantes que les autres. Dans cette étude, la formation de biofilm et une antibiorésistance sont fréquemment observées.

Genetic characterization of canine parvovirus from dogs in Pakistan.

Canine parvoviruses (CPV) exist as antigenic variants with varying frequencies and genetic variabilities across the globe. Given the endemicity and high prevalence in Pakistan, we characterized the CPVs originating from dogs-population to elucidate viral diversity and evolution. Fecal samples from clinically diseased pups (n = 17) of different breeds and age (2-6 months) were processed for hemagglutination assay (HA), and later for partial amplification of VP2 gene sequence and amino acid analysis. A total of 11 samples (64.71%) were found positive both in hemagglutination and PCR assays. Phylogenetic and evolutionary analysis demonstrated higher genetic heterogeneity in studied strains and constituted seven clusters within the CPV-2a group, however, they shared high level of identity with Chinese strains. Further studies are necessary to elucidate genetic analysis and epidemiology of CPV variants across a wide geographical area of the country.

Phase-amplitude coupling and the BOLD signal: A simultaneous intracranial EEG (icEEG) - fMRI study in humans performing a finger-tapping task.

Although it has been consistently found that local blood-oxygen-level-dependent (BOLD) changes are better modelled by a combination of the power of multiple EEG frequency bands rather than by the power of a unique band alone, the local electro-haemodynamic coupling function is not yet fully characterised. Electrophysiological studies have revealed that the strength of the coupling between the phase of low- and the amplitude of high- frequency EEG activities (phase-amplitude coupling - PAC) has an important role in brain function in general, and in preparation and execution of movement in particular. Using electrocorticographic (ECoG) and functional magnetic resonance imaging (fMRI) data recorded simultaneously in humans performing a finger-tapping task, we investigated the single-trial relationship between the amplitude of the BOLD signal and the strength of PAC and the power of α, ß, and γ bands, at a local level. In line with previous studies, we found a positive correlation for the γ band, and negative correlations for the PACßγ strength, and the α and ß bands. More importantly, we found that the PACßγ strength explained variance of the amplitude of the BOLD signal that was not explained by a combination of the α, ß, and γ band powers. Our main finding sheds further light on the distinct nature of PAC as a functionally relevant mechanism and suggests that the sensitivity of EEG-informed fMRI studies may increase by including the PAC strength in the BOLD signal model, in addition to the power of the low- and high- frequency EEG bands.

Brain-computer interfaces in the completely locked-in state and chronic stroke.

Brain-computer interfaces (BCIs) use brain activity to control external devices, facilitating paralyzed patients to interact with the environment. In this chapter, we discuss the historical perspective of development of BCIs and the current advances of noninvasive BCIs for communication in patients with amyotrophic lateral sclerosis and for restoration of motor impairment after severe stroke. Distinct techniques have been explored to control a BCI in patient population especially electroencephalography (EEG) and more recently near-infrared spectroscopy (NIRS) because of their noninvasive nature and low cost. Previous studies demonstrated successful communication of patients with locked-in state (LIS) using EEG- and invasive electrocorticography-BCI and intracortical recordings when patients still showed residual eye control, but not with patients with complete LIS (ie, complete paralysis). Recently, a NIRS-BCI and classical conditioning procedure was introduced, allowing communication in patients in the complete locked-in state (CLIS). In severe chronic stroke without residual hand function first results indicate a possible superior motor rehabilitation to available treatment using BCI training. Here we present an overview of the available studies and recent results, which open new doors for communication, in the completely paralyzed and rehabilitation in severely affected stroke patients. We also reflect on and describe possible neuronal and learning mechanisms responsible for BCI control and perspective for future BMI research for communication in CLIS and stroke motor recovery.

A study of the electro-haemodynamic coupling using simultaneously acquired intracranial EEG and fMRI data in humans.

In current fMRI studies designed to map BOLD changes related to interictal epileptiform discharges (IED), which are recorded on simultaneous EEG, the information contained in the morphology and field extent of the EEG events is exclusively used for their classification. Usually, a BOLD predictor based on IED onset times alone is constructed, effectively treating all events as identical. We used intracranial EEG (icEEG)-fMRI data simultaneously recorded in humans to investigate the effect of including any of the features: amplitude, width (duration), slope of the rising phase, energy (area under the curve), or spatial field extent (number of contacts over which the sharp wave was observed) of the fast wave of the IED (the sharp wave), into the BOLD model, to better understand the neurophysiological origin of sharp wave-related BOLD changes, in the immediate vicinity of the recording contacts. Among the features considered, the width was the only one found to explain a significant amount of additional variance, suggesting that the amplitude of the BOLD signal depends more on the duration of the underlying field potential (reflected in the sharp wave width) than on the degree of neuronal activity synchrony (reflected in the sharp wave amplitude), and, consequently, that including inter-event variations of the sharp wave width in the BOLD signal model may increase the sensitivity of forthcoming EEG-fMRI studies of epileptic activity.

Brain-machine interface (BMI) in paralysis.

INTRODUCTION: Brain-machine interfaces (BMIs) use brain activity to control external devices, facilitating paralyzed patients to interact with the environment. In this review, we focus on the current advances of non-invasive BMIs for communication in patients with amyotrophic lateral sclerosis (ALS) and for restoration of motor impairment after severe stroke. BMI FOR ALS PATIENTS: BMI represents a promising strategy to establish communication with paralyzed ALS patients as it does not need muscle engagement for its use. Distinct techniques have been explored to assess brain neurophysiology to control BMI for patients' communication, especially electroencephalography (EEG) and more recently near-infrared spectroscopy (NIRS). Previous studies demonstrated successful communication with ALS patients using EEG-BMI when patients still showed residual eye control, but patients with complete paralysis were unable to communicate with this system. We recently introduced functional NIRS (fNIRS)-BMI for communication in ALS patients in the complete locked-in syndrome (i.e., when ALS patients are unable to engage any muscle), opening new doors for communication in ALS patients after complete paralysis. BMI FOR STROKE MOTOR RECOVERY: In addition to assisted communication, BMI is also being extensively studied for motor recovery after stroke. BMI for stroke motor recovery includes intensive BMI training linking brain activity related to patient's intention to move the paretic limb with the contingent sensory feedback of the paretic limb movement guided by assistive devices. BMI studies in this area are mainly focused on EEG- or magnetoencephalography (MEG)-BMI systems due to their high temporal resolution, which facilitates online contingency between intention to move and sensory feedback of the intended movement. EEG-BMI training was recently demonstrated in a controlled study to significantly improve motor performance in stroke patients with severe paresis. Neural basis for BMI-induced restoration of motor function and perspectives for future BMI research for stroke motor recovery are discussed.

Classification of EEG abnormalities in partial epilepsy with simultaneous EEG-fMRI recordings.

Scalp EEG recordings and the classification of interictal epileptiform discharges (IED) in patients with epilepsy provide valuable information about the epileptogenic network, particularly by defining the boundaries of the "irritative zone" (IZ), and hence are helpful during pre-surgical evaluation of patients with severe refractory epilepsies. The current detection and classification of epileptiform signals essentially rely on expert observers. This is a very time-consuming procedure, which also leads to inter-observer variability. Here, we propose a novel approach to automatically classify epileptic activity and show how this method provides critical and reliable information related to the IZ localization beyond the one provided by previous approaches. We applied Wave_clus, an automatic spike sorting algorithm, for the classification of IED visually identified from pre-surgical simultaneous Electroencephalogram-functional Magnetic Resonance Imagining (EEG-fMRI) recordings in 8 patients affected by refractory partial epilepsy candidate for surgery. For each patient, two fMRI analyses were performed: one based on the visual classification and one based on the algorithmic sorting. This novel approach successfully identified a total of 29 IED classes (compared to 26 for visual identification). The general concordance between methods was good, providing a full match of EEG patterns in 2 cases, additional EEG information in 2 other cases and, in general, covering EEG patterns of the same areas as expert classification in 7 of the 8 cases. Most notably, evaluation of the method with EEG-fMRI data analysis showed hemodynamic maps related to the majority of IED classes representing improved performance than the visual IED classification-based analysis (72% versus 50%). Furthermore, the IED-related BOLD changes revealed by using the algorithm were localized within the presumed IZ for a larger number of IED classes (9) in a greater number of patients than the expert classification (7 and 5, respectively). In contrast, in only one case presented the new algorithm resulted in fewer classes and activation areas. We propose that the use of automated spike sorting algorithms to classify IED provides an efficient tool for mapping IED-related fMRI changes and increases the EEG-fMRI clinical value for the pre-surgical assessment of patients with severe epilepsy.

Improving the sensitivity of EEG-fMRI studies of epileptic activity by modelling eye blinks, swallowing and other video-EEG detected physiological confounds.

RATIONALE: To improve the sensitivity and specificity of simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI) it is prudent to devise modelling strategies explaining the residual variance. The purpose of this study is to investigate the potential value of including additional regressors for physiological activities, derived from video-EEG, in the modelling of haemodynamic patterns linked to interictal epileptiform discharges (IEDs) using simultaneously recorded video-EEG-fMRI. METHODS: Ten patients with IED (focal epilepsy: 6, idiopathic generalized epilepsy (IGE):4) were studied. BOLD-sensitive fMRI images were acquired on a 3T MRI scanner. 64-channel EEG was recorded using MR-compatible system. A custom made, dual-video-camera system synchronised with EEG was used to record video simultaneously. IEDs and physiological activities were identified and labelled on video-EEG using Brain Analyzer2. fMRI time-series data were pre-processed and analysed using SPM5 software. Two general linear models (GLM) were created; GLM1: IEDs were convolved with the canonical haemodynamic response function and its derivatives. Realignment parameters and pulse regressors were included in the design matrix as confounds, GLM2: GLM1 and additional regressors identified on video-EEG including: eye blinks, hand or foot movement, chewing and swallowing were also included in the design matrix. SPM [F] maps (p<0.05, corrected for family wise error and p<0.001, uncorrected) were generated for both models. We compared the resulting blood oxygen level dependent (BOLD) maps for cluster size, statistical significance and degree of concordance with the irritative zone. RESULTS: BOLD changes relating to physiological activities were generally seen in expected brain areas. In patients with focal epilepsy, the extent and Z-score of the IED-related global maximum BOLD clusters increased in 4/6 patients and additional IED-related BOLD clusters were observed in 3/6 patients for GLM2. Also, the degree of concordance of IED-related maps with irritative zone improved for one patient for GLM2 and was unchanged for the other cases. In patients with IGE, the size and statistical significance for global maximum and other BOLD clusters increased in 2/4 patients. We conclude that the inclusion of additional regressors, derived from video based information, in the design matrix explains a greater amount of variance and can reveal additional IED-related BOLD clusters which may be part of the epileptic networks.

Risk factors associated with low birth weight.

BACKGROUND: Babies with a birth weight of less than 2500 grams, irrespective of the period of their gestation are termed as Low Birth Weight (LBW) babies. Despite consistent efforts to improve the quality of maternal and child health, more than twenty million low birth-weight (LBW) babies are born every year throughout the world. Though, the health situation of Nepal has improved substantially over the years, the low birth-weight (LBW) rate still high. The present study was to explore the effects of various maternal risk factors associated with low birth-weight of institutionally delivered newborns. METHODS: A cross sectional hospital based study was conducted in Obstetrics and Gynaecology ward of Janakpur Zonal Hospital, Janakpur, Nepal from December 2009 to January 2010. Altogether 306 respondents were taken and respondents were mothers who have delivered newborns in hospital. RESULTS: A total of 1426 birth occurred during the study period (December 2009 to January 2010), of which 306 met the study criteria. Among which 66 (21.56%) were low birth weight (LBW) and 240 were normal birth weight (NBW). Overall mean birth weight was found to be 2.75 ± 0.639 kg. Out of total 21.56% newborns were weighing less than 2.50 kg and mean birth weight was 1.96 ± 0.409 kg. The study also shows that majority 73 (86%) of the research centers didn't start the research yet. CONCLUSIONS: This study suggests that there are several factors interplaying which lead to LBW babies. Socio-demographic factors (maternal age, educational level and economic status) and antenatal care are more important.

Acanthamoeba keratitis with Curvularia co-infection.

We report a case of Acanthamoeba keratitis with Curvularia co-infection. Acanthamoeba and fungal co-infection have been uncommonly reported in literature, worldwide. A classical history with a strong clinical suspicion and experienced laboratory personnel with systematic examination of corneal scrapings for bacterial, viral, parasitic and fungal causes are imperative for accurate diagnosis. Early diagnosis of Acanthamoeba keratitis or fungal infection followed by aggressive and appropriate treatment with effective agents is critical for the retention of good vision. Acanthamoeba keratitis is difficult to diagnose and, despite improvement in treatment options, may culminate in prolonged morbidity and significant loss of visual acuity. This case emphasizes the important role played by clinical microbiologists in making prompt diagnosis which can ultimately reduce visual morbidity.

The Microbleed Anatomical Rating Scale (MARS): reliability of a tool to map brain microbleeds.

OBJECTIVE: Brain microbleeds on gradient-recalled echo (GRE) T2*-weighted MRI may be a useful biomarker for bleeding-prone small vessel diseases, with potential relevance for diagnosis, prognosis (especially for antithrombotic-related bleeding risk), and understanding mechanisms of symptoms, including cognitive impairment. To address these questions, it is necessary to reliably measure their presence and distribution in the brain. We designed and systematically validated the Microbleed Anatomical Rating Scale (MARS). We measured intrarater and interrater agreement for presence, number, and anatomical distribution of microbleeds using MARS across different MRI sequences and levels of observer experience. METHODS: We studied a population of 301 unselected consecutive patients admitted to our stroke unit using 2 GRE T2*-weighted MRI sequences (echo time [TE] 40 and 26 ms). Two independent raters with different MRI rating expertise identified, counted, and anatomically categorized microbleeds. RESULTS: At TE = 40 ms, agreement for microbleed presence in any brain location was good to very good (intrarater kappa = 0.85 [95% confidence interval (CI) 0.77-0.93]; interrater kappa = 0.68 [95% CI 0.58-0.78]). Good to very good agreement was reached for the presence of microbleeds in each anatomical region and in individual cerebral lobes. Intrarater and interrater reliability for the number of microbleeds was excellent (intraclass correlation coefficient [ICC] = 0.98 [95% CI 0.97-0.99] and ICC = 0.93 [0.91-0.94]). Very good interrater reliability was obtained at TE = 26 ms (kappa = 0.87 [95% CI 0.61-1]) for definite microbleeds in any location. CONCLUSION: The Microbleed Anatomical Rating Scale has good intrarater and interrater reliability for the presence of definite microbleeds in all brain locations when applied to different MRI sequences and levels of observer experience.

Neo-adjuvant chemotherapy for muscle-invasive bladder cancer: a look ahead.

Randomized clinical trials of neo-adjuvant cisplatin-based combination chemotherapy for locally advanced muscle invasive bladder cancer has shown a survival benefit over cystectomy alone. Pathologic complete response (pT0) after neo-adjuvant chemotherapy is emerging as a potentially important surrogate clinical end point. Future clinical trials incorporating targeted therapies with novel clinical end points may accelerate development of therapeutic strategies for locally advanced muscle invasive bladder cancer. Furthermore, evaluation of molecular markers may further help to stratify patients to a risk adapted approach.

Quality of life in men with localized prostate cancer treated by radical prostatectomy or radiotherapy.

Radical prostatectomy and radiotherapy are the most commonly utilized modalities for managing patients with localized prostate cancer. Each has effects on quality of life that are important in decision making. Long term side effects of these treatment modalities include urinary, bowel and sexual dysfunction, and have been documented. Comparison of the side effects of these different modalities continues to be explored, emphasizing their effects on quality of life (QOL) from the patient's viewpoint. Questionnaires were mailed to 224 eligible patients and a response was elicited in 161 men (72%). The final number of patients who completed all the questionnaires was 151. Of these, 73 (48%) had radical prostatectomy and 78 (52%) had radiotherapy. General well being measures demonstrated a definite advantage favoring men treated with radical prostatectomy. Prostate cancer specific QOL measures were similar among men treated with surgery or radiotherapy. Radiotherapy treated men were slightly more likely to report bowel-related problems than surgically treated men. Urinary QOL measures were no different between treated groups. Surgically treated men reported lower level of sexual function than radiotherapy treated men.

Extended spectrum -lactamases (ESBL) - an emerging threat to clinical therapeutics.

Extended spectrum -lactamases (ESBLs) are plasmid mediated, TEM and SHV derived enzymes, first isolated in Western Europe in mid 1980s, most commonly in Klebsiella spp., followed by Escherichia coli. These enzymes are capable of hydrolyzing broad spectrum cephalosporins and monobactams but inactive against cephamycins and imipenem. In addition, ESBL producing organisms exhibit coresistance to many other classes of antibiotics resulting in limitation of therapeutic option. Several risk factors have been suggested. A variety of classification schemes have been developed. Recently, Bush-Jacoby-Medeiros scheme integrated functional and molecular characteristics. ESBLs have serine at their active site and attack the amide bond in the lactam ring of antibiotics causing their hydrolysis. Because of inocolum effect and substrate specificity their detection is a major challenge. Two indicators of ESBLs are eight fold reduction in MIC and potentiation of the inhibitor zone of third generation cephalosporin in the presence of clavulanic acid. Incidence of these organisms is being continuously increasing through out the world with limited treatment alternatives. It becomes necessary to know the prevalence of these organisms and to formulate treatment policy. Moreover, restricted use of the third generation cephalosporins lead to withdrawal of selective pressure and use of lactam and -lactamase inhibitor combinations may exert reverse mutation on these enzymes.

Fertility after chemotherapy for testicular cancer.

Disseminated testicular cancer has largely become curable with cisplatin-based chemotherapy. The prospect of fertility after treatment is an important consideration for both patients and clinicians. While there may be an irreversible impairment of spermatogenesis at a cumulative cisplatin dose of greater than 400 mg/m2, a low sperm count does not necessarily appear to prevent fatherhood. This review summarizes currently available data on the effects of chemotherapy on male fertility and steps that can be taken to preserve fertility in this patient population.

Intermittent androgen deprivation: update of cycling characteristics in patients without clinically apparent metastatic prostate cancer.

OBJECTIVES: To update the cycling characteristics and patterns of treatment in patients receiving intermittent androgen deprivation (IAD) for clinically localized and recurrent prostate cancer. METHODS: We report our experience with 61 patients treated with IAD. Thirty-four patients had received no prior treatment, and 27 had developed recurrent disease after previous local therapy. No patient had clinically apparent metastatic disease before the initiation of therapy. The mean and median serum prostate-specific antigen (PSA) level before treatment was 25.3 ng/mL and 16.0 ng/mL, respectively (range 0.5 to 190 ng/mL). For each cycle, androgen deprivation was continued until PSA became undetectable or a nadir level was reached. Patients were then observed without treatment, and therapy was reinstituted after the serum PSA value reached a predetermined level. Patients were no longer eligible to cycle off treatment when their serum PSA increased despite ongoing androgen deprivation or if any objective evidence of disease progression was present on imaging studies. RESULTS: Follow-up ranged from 7 to 60 months (mean 30) from the start of treatment. Patients received from one to five treatment cycles (median two), with a median cycle length of 14 months. The median nadir serum PSA level during androgen deprivation was 0.01 ng/mL and was reached within an average of 6 months (range 4 to 9) after beginning treatment. Patients spent an average of 45% of the time not receiving therapy, but the time off therapy decreased as the number of treatment cycles increased. Five patients (8.1%) demonstrated progressive disease, with a median time to progression of 48 months. When examining the cycling characteristics of these patients, no consistent pattern of failure emerged. CONCLUSIONS: IAD appears to be a viable treatment option in select patients with localized prostate cancer. With each consecutive cycle, the amount of time the patient was not receiving therapy decreased, despite achieving a low nadir PSA. Longer follow-up with more patients failing IAD will be required before clear patterns of failure emerge in these patients.

Purification, cloning, and DNA sequence analysis of a chitinase from an overproducing mutant of Streptomyces peucetius defective in daunorubicin biosynthesis.

Extracellular chitinases of Streptomyces peucetius and a chitinase overproducing mutant, SPVI, were purified to homogeneity by ion exchange and gel filtration chromatography. The purified enzyme has a molecular mass of 42 kDa on SDS-PAGE, and the N-terminal amino acid sequence of the protein from the wild type showed homology to catalytic domains (Domain IV) of several other Streptomyces chitinases such as S. lividans 66, S. coelicolor A3(2), S. plicatus, and S. thermoviolaceus OPC-520. Purified SPVI chitinase cross-reacted to anti-chitinase antibodies of wild-type S. peucetius chitinase. A genomic library of SPVI constructed in E. coli using lambda DASH II was probed with chiC of S. lividans 66 to screen for the chitinase gene. A 2.7 kb fragment containing the chitinase gene was subcloned from a lambda DASH II clone, and sequenced. The deduced protein had a molecular mass of 68 kDa, and showed domain organization similar to that of S. lividans 66 chiC. The N-terminal amino acid sequence of the purified S. peucetius chitinase matched with the N-terminus of the catalytic domain, indicating the proteolytic processing of 68 kDa chitinase precursor protein to 42 kDa mature chitinase containing the catalytic domain only. A putative chiR sequence of a two-component regulatory system was found upstream of the chiC sequence.

Effect of water extract of the bark of Buchanania lanzan linn. on behaviour and chromatophores of a fresh water fish, Labeo rohita.

Fish exposed to 150 ppm and 250 ppm doses saparately, showed eratic swimming with hyper-excitability, spiralling, convulsion and mortality. However at 350 ppm dose fish became lethargic and steady at the bottom of aquarium. This behaviour appears to be due to sedative effects of fish implicating the phychoactive nature of the plant B. Ianzan. At 150 ppm to 350 ppm doses, fish scale changed from reticulate to punctate chromatophores; and treated fish when transferred to fresh water, were slowly regained to normal behaviour after 96 h exposure. Hence doses regaining from 150 ppm to 350 ppm is considered to be psychoative in nature. In higher doses 450 ppm and 550 ppm fish could survive only 76 h and 4.30 h respectively and then died indicating toxicity of plant for the said doses. It is found that scale present on its body is most suitable test system for the study of psychoactivity and toxicity of plant extracts on fish, Labeo rohita.