Parathyroid Adenoma In A Young Female Presenting With Craniofacial Brown Tumor And Acute Pancreatitis – A Case Report

Solitary Parathyroid adenomas have a diverse clinical presentation. They may be asymptomatic or may sometimes lead to extensive bony resorption and replacement of bone by fibrous tissue, also known as a brown tumor. Brown tumor is a relatively rare presentation of primary hyperparathyroidism and is even rarer in a younger age group. Here, we report the case of a 20-year-old female presenting with craniofacial brown tumor and during the course of hospital stay; she also developed an attack of acute pancreatitis due to hyperparathyroidism. This case report emphasizes the importance of a complete investigative work up in patients presenting with maxillofacial bony lesions for early diagnosis and planning of definitive management.

Antibacterial Activity of Nigella Sativa Linn. Seeds Against Multiple Antibiotics Resistant Clinical Strains of Staphylococcus aureus

Objective: Staphylococcus aureus is one of the major resistant pathogens extremely adaptable to antibiotic pressure. Nigella sativa (black cumin) seed extracts and essential oil have been shown to possess antimicrobial activity against several bacteria but little work has been done on their effect against multidrug resistant S. aureus strains isolated from patients. So, we studied antibacterial activity of Nigella sativa against multidrug resistant clinical strains of Staphylococcus aureus. It was an experimental, in vitro study. Materials and methods: Nigella sativa (black cumin) seed essential oil and extracts were tested in varying dilutions against 40 clinical strains of Staphylococcus aureus which were isolated from patients attending a tertiary care teaching hospital in North India using disc agar diffusion technique on inoculated Muellar Hinton agar plates under standard laboratory conditions. The tested strains were resistant to 4 or more clinically used antibiotics belonging to at least 3 different classes. Results: The Methanolic extract and oil of Nigella sativa were found active against 38 and 35 multi-drug resistant strains respectively. Both the oil and Methanolic extract showed remarkable dose dependant antibacterial activity against the tested strains up to a dilution of 1:50 as evident from the zones of inhibition. Conclusion: Nigella sativa possesses antibacterial activity against multidrug resistant clinical strains of Staphylococcus aureus

Chronic suppurative otitis media: a clinico-microbiological menace.

Background: Chronic Suppurative Otitis Media (CSOM) is an important cause of preventable hearing loss. Global emergence of resistant strains is of great concern. The aim of the present study was to determine the etiology and antibiotic sensitivity pattern of bacterial isolates from CSOM cases with special emphasis on ESBL (Extended Spectrum Beta- Lactamases) and AmpC beta lactamases. Methods: Patients with sign and symptoms suggestive of CSOM, ESBL (Extended Spectrum Beta-Lactamases), AmpC beta lactamases and MBLs (Metallo beta lactamases) were included. Two ear swabs were taken from all the patients and cultured on blood agar and MacConkey agar. Bacterial identification of isolates was done using standard biochemicals. Antimicrobial susceptibility was performed by Kirby-Bauer's disc diffusion method as per the Clinical Laboratory Standards Institute (CLSI) guidelines using antibiotic discs (HI MEDIA). Results: Out of 130 patients, 110(84.62%) had bacterial growth. The common pathogenic species were Pseudomonas aeruginosa 36(37.89%), Staphylococcus aureus 31(32.63%), Citrobacter koseri 9(9.47%) and Proteus vulgaris 6(6.32%). P. aeruginosa showed maximum sensitivity to colistin (94.4%), polymixin-B (91.3%) and imipenem (91.3%). Gram positive cocci showed maximum sensitivity to vancomycin (99%). MRSA (Methicillin Resistant Staphylococcus aureus) and HLAR (High Level Aminoglycoside Resistance) were detected in 9(29%) S. aureus and 1(50%) Enterococcus faecalis respectively. ESBL and AmpC were detected in 11(18.3%) and 12(20%) Gram negative bacteria, respectively and MBL producer was not detected. Conclusion: P. aeruginosa was found to be the most common isolate in CSOM cases and colistin, polymixin-B and imipenem was found to be most effective antibiotics.

Prevalence of genotype D in chronic liver disease patients with occult HBV infection in northern region of India.

Background: Etiology of nearly 30% cases of chronic viral hepatitis remains undetected. Occult HBV infection (OBI) has emerged as an important clinical entity in this scenario. Apart from prevalence and clinical outcome of OBI patients genotype was determined in northern region of India. Materials and Methods: A total of 847 patients with chronic liver disease (CLD) were screened for common viral etiologies and others serological markers of HBV. Amplifi cation of surface, precore and polymerase genes of HBV was performed in patients negative for other etiologies. Genotyping and sequencing of the precore region was performed for OBI cases. Results: Twenty-nine (7.61%) cases of OBI were identifi edof which 9 had chronic liver disease (CHD), 11 liver cirrhosis (LC) and 9 hepatocellular carcinoma (HCC). Majority of OBI cases were detected by amplifi cation of surface gene 26 (89.6%), followed by pre-core gene 12 (41.3%). Their liver functions tests were signifi cantly deranged in comparison to overt HBV cases. IgG anti HBc was present in 8 (27.6%) OBI cases. Mutation was observed in 8 (32%) in pre-core region at nt. 1896 of overt HBV cases. Genotype D was the predominant genotype. In conclusion: OBI in our study was characterized by predominance of genotype D and more severe clinical and biochemical profi le in comparison to overt HBV. IgG anti HBc positivity could be utilized as a marker of OBI. We recommend use of sensitive nested PCR for diagnosis of OBI, amplifying at least surface and precore gene.

Pulsatile Drug Delivery System: an Approach of Medication according to Circadian Rhythm.

Pulsatile drug delivery systems are developed to deliver drug according to circadian behavior of diseases. This means that these systems will deliver drug at time when disease display it’s most morbid and mortal state within a circadian cycle (24 hrs.). The product follow a sigmoidal drug release profile characterized by a time period of no release (lag time) followed by a rapid and complete drug release. Thus drug can be delivered at right time, in right amount and at right site of action by use of such approach. The potential benefits of chronotherapeutics have been investigated and established for number of diseases like asthma, arthritis, cancer, diabetes, epilepsy, hypertension, ulcer, hypercholesterolemia etc. Various capsular, osmotic, single and multiple unit systems that are modulated by soluble or erodible polymer coatings, rupturable membranes are available in market. These systems are beneficial for diseases showing chronopharmacological behavior where night time dosing is required or for the drugs having high first pass effect or having site specific absorption in GIT, or for drugs with high risk of toxicity or tolerance. These systems also improve patient compliance by decreasing dosing frequency.

Antibacterial activity of leaves extracts of Trifolium alexandrinum Linn. against pathogenic bacteria causing tropical diseases

Objective: To investigate antibacterial potential of Trifolium alexandrinum (T. alexandrinum) Linn. against seven gram positive and eleven gram negative hospital isolated human pathogenic bacterial strains responsible for many tropical diseases. Methods: Non-polar and polar extracts of the leaves of T. alexandrinum i.e., hexane, dichloromethane (DCM), ethyl acetate (EtOAc), methanol (MeOH) and aqueous (AQ) extracts at five different concentrations (1, 2, 5, 10 and 15 mg/mL) were prepared to evaluate their antibacterial value. NCCL standards were strictly followed to perform antimicrobial disc susceptibility test using disc diffusion method. Results: Polar extracts demonstrated significant antibacterial activity against tested pathogens. EtOAc and MeOH extracts showed maximum antibacterial activity with higher inhibition zone and were found effective against seventeen of the tested pathogens. While AQ plant extract inhibited the growth of sixteen of the test strains. EtOAc and MeOH plant extracts inhibited the growth of all seven gram positive and ten of the gram negative bacterial strains. Conclusions: The present study strongly confirms the effectiveness of crude leaves extracts against tested human pathogenic bacterial strains causing several tropical diseases. Since Egyptian clover is used as a fodder plant, it could be helpful in controlling various infectious diseases associated with cattle as well.

Typhidot M and Diazo test vis-à-vis blood culture and Widal test in the early diagnosis of typhoid fever in children in a resource poor setting

OBJECTIVE: Typhoid fever is a major public health problem. A test which is simple, reliable and can be carried out in small laboratories is the need of the hour. We prospectively evaluated typhidot M and Diazo tests vis-à-vis blood culture and Widal test in children. METHODS: Patients aged 6 months to 12 years, having fever of more than four days duration with clinical suspicion of typhoid fever were enrolled. Patients in whom other diagnosis was made served as control. The tests under scrutiny were validated against blood culture and then all the four tests were evaluated among patients who presented in the first week of illness. RESULTS: Blood culture was positive in only 27.3 percent of the cases. Among these culture positive cases, typhidot M test had the highest sensitivity, specificity, PPV and NPV of 90 percent (95 percent CI = 74.4-96.5), 100 percent (95 percent CI = 90.1-100), 100 percent (95 percent CI = 87.5-100), and 92.1 percent (95 percent CI = 79.2-97.3) respectively. Diazo test ranked next with sensitivity, specificity, PPV and NPV of 86.7 percent (95 percent CI = 70.3-94.7), 85.7 percent (95 percent CI = 70.6-93.7), 83.9 percent (95 percent CI = 67.4-92.9), 88.2 percent (95 percent CI = 73.4-95.3) respectively. Among clinically suspected typhoid cases, the overall sensitivity, of blood culture, Widal, typhidot M, Diazo was 27.3 percent (95 percent CI = 19.8- 36.3), 64.6 percent (95 percent CI = 55.3-72.9), 89.1 percent (95 percent CI = 81.9-93.7), 80.9 percent (95 percent CI = 72.6-87.2) respectively. In the first week of illness, typhidot M showed the best sensitivity [86.2 percent (95 percent CI = 69.4-94.5)] followed by Diazo [79 percent (95 percent CI = 61.6-90.2)], Widal [41.4 percent (95 percent CI = 25.5-59.3)] and blood culture [31 percent (95 percent CI = 17.3-49.2)]. CONCLUSION: Both Typhidot M and Diazo are good screening tests for the diagnosis of typhoid fever. Typhidot M is superior to Diazo but the latter is more suitable to resource poor settings being economic and easy to perform.

Antibacterial efficacy of Bacopa monnieri leaf extracts against pathogenic bacteria.

Background: Bacopa monnieri (Linn) Pennell (Scrophulariaceae) is widely distributed in tropical regions of Asia, and used in the treatment of cough or as an antiseptic. The traditional use of this plant suggests its possible antibacterial properties, but its efficacy has not been examined yet. Objective: Evaluate the antibacterial efficacy against pathogenic bacteria using the disk diffusion method. Materials and methods: Five different concentrations (500 μg, 1, 2, 5, 10, and 15 mg/mL) of crude leaf extracts of Bacopa monnieri (L.) Pennell were tested for antibacterial efficacy against seven Gram-positive and 11 Gramnegative bacteria. The sensitivity of plant fractions was tested using the disk diffusion method. Results: Maximum activity was revealed by ethyl acetate and methanol extracts, followed by aqueous, benzene, and petrol extracts. Phyto-chemical analysis of the plant leaf showed the presence of alkaloids, flavonoids, and saponins. Conclusion: This plant may be effective for treatment of different pathogenic diseases.

Screening children with severe short stature for celiac disease using tissue transglutaminase.

Objective. To determine the prevalence of anti-tissue transglutaminase in children and adolescents with severe short stature (<-3 SD). Methods. All children in age group of 1-18 years having height less than -3 SD for their age and sex, were included. For each child age and sex matched healthy control (height more than -2 SD) was taken. The included subjects (study & control group) were subjected to anti tissue transglutaminase (tTG) (IgA) antibody assay estimation. Results. Of the 112 cases, 23 were tTG positive, giving a prevalence of 20.5% for seropositivity among cases of short stature while all the controls were seronegative for tTG. All the 23 had tTG values above 40 U/ml and 11 had values above 100 U/ ml. On univariate analysis we found that the presence of chronic diarrhea (OR = 2.55, 95%CI - 1.08-5.98), bulky stools (OR = 3.03, 95%CI - 1.52-6.05), hemoglobin < 7 gm/dl (OR = 3.12, 95%CI - 1.55 - 6.29) and more severe short stature (<-4 SD) (OR = 0.41, 95%CI - 0.17- 0.95) had significant association with the tTG positivity. On logistic regression analysis in all cases, hemoglobin < 7gm/dl (OR = 0.090, 95%CI = 0.024-0.342) and bulky stools (OR=0.212, 95%CI = 0.069-0.649) were significantly associated with tTG positivity. Conclusion. More than one fifth of all severe short stature are seropositive for tTG and the chances of seropositivity increases if severe anemia and bulky stool are also associated.

Antibody levels against polioviruses in children following Pulse Polio Immunization Program.

This cross sectional study was performed in a tertiary level teaching hospital to evaluate and compare the antibody levels in children below 6 years who had received oral polio vaccination through Pulse Polio Immunization (PPI) with those children who had received both routine immunization as well as PPI. Detail history of polio immunization was taken. Serum samples were then collected for antibody determination by neutralization tests with standard polio viruses using Vero cell lines. Total 400 children were studied; 14 were found unvaccinated. Out of the remaining 386 (96.5%) vaccinated children, 292 (75%) had received both routine and pulse polio immunization, 68 (17%) had only PPI while 26 (6.7%) had received only routine immunization. The seropositivity was lowest for P3 and highest for P2. Overall seroprevalence for PI, P2 and P3 in vaccinated children was 89.1%, 93% and 80.6% respectively, and did not differ significantly between the three vaccinated subgroups. However, children who were immunized by both routine and PPI had higher geometric mean titers (315.5, 484.7 and 187.4 for PI, P2 and P3 respectively) when compared with those who had received only PPI (P<0.001 for each PI, P2 and P3), as well as those who had received only routine immunization with OPV (P<0.05 for PI, p<0.001 for P2, and P<0.01 for P3). Despite the reasonable immunization coverage in study population, there were 29 (7.25%) triple negative cases. Hence other causes of low seroconversion should also be considered to achieve polio free India.