A Rare Case Report of Leprous Macrocheilia in Borderline Tuberculoid Leprosy with Type 1 Reaction

It is well known that Mycobacterium leprae tends to target the cooler parts of the body and can involve the oral cavity. Despite this, macrocheilia - a condition where the lips become enlarged - caused by leprosy is rarely documented. There are few reported cases of leprous macrocheilia in India. We present a unique case of an elderly woman with borderline tuberculoid leprosy in type I reaction who developed leprous macrocheilia.

A preliminary assessment of availability and pricing of children’s medicines in government hospitals and private retail pharmacies in a district of West Bengal in India

Background: A lack of availability of suitable pediatric formulation and high price are often the major hindrance to the better access of the essential treatment to the children. In the backdrop of paucity of literature addressing this problem in India and in particular West Bengal, the present work was planned. Aim and Objectives: This study has been a maiden approach to generate data regarding this issue in small scale and in an inexpensive way after conducting a survey in different government and private facilities in a district of West Bengal, India. Materials and Methods: This cross-sectional study used “WHO Children’s Medicines Survey Form” to make a rapid assessment of availability and pricing of 20 core children’s medicine formulations among ten government hospitals and nine private retail pharmacies in the district of Burdwan in West Bengal during September-October 2009. In retail pharmacies, the actual price to the patient of the cheapest brand was documented. In public health facilities, procurement prices for medicines were obtained from state government’s Central Medical Stores (CMS) listing. Results: Overall, the availability was sub-optimal in all levels of public health facilities-30% in medical college pharmacy, 33% in the district reserve stores, 33.75% in sub-divisional hospitals, 32.25% in primary health centers, and in retail pharmacies was only 45%. Out of the 20 formulations, only two (ORS, paracetamol) were available in all the public and private retail pharmacies. Availability of anti-infectives was better than other medicines in both types of facilities. The variation of prices among different brands was wide. The cost of even the cheapest brand was much higher than corresponding government procurement price. Conclusion: This maiden effort reveals sub-optimal availability of core essential medicines for children in both public facilities and private retail pharmacies. However, medicines available in private pharmacies were much costlier compared to CMS procurement price. This is a matter of concern. A larger nation-wide study is the need of the hour with a greater focus on affordability and prescribing behavior.

The Impact of the COVID-19 Pandemic on Health-Care Delivery System for Other Diseases and Antimicrobial Resistance Threat in India

India’s health‑care delivery is challenged with different inequalities and the dual burden of communicable and noncommunicable diseases. Lockdown posed negative effects on the growth and economy of the country; simultaneously, some positive effects, like increased health consciousness and adoption of hygienic practices, were also there. Health‑care delivery system faced tremendous challenges in diagnostics, therapeutics, infrastructure for inpatient care, and protection of health‑care manpower. During this period, people chose to self medicate which in turn increased the threat of emergence of antimicrobial resistance. Due to shifting priority to COVID from other diseases, resources were shifted to COVID, affecting the management of other acute and chronic diseases. The launching of COVID‑19 vaccination campaign showed some hope. However, despite the vaccination drive, strengthening infrastructure, and surveillance system, the devastating second wave could not be avoided due to the conglomeration of the crowd for pilgrimage, election campaign, and tourism in an unrestricted manner. It may be concluded that the fourth wave may be short lasting due to increased herd immunity.

A comparative study of timolol plus either brimonidine (0.2%) or dorzolamide (2%) or latanoprost (0.005%) dual therapy in suboptimal responders to timolol (0.5%) monotherapy among patients of open-angle glaucoma, ocular hypertension and normal-tension glaucoma

Background: Studies comparing the efficacy and tolerability of the three fixed combinations of timolol with its monotherapy are not readily available. In this background, the current prospective observational study was planned. Aim and Objective: To evaluate and compare the intraocular pressure (IOP) reduction, change in visual field, and cup-disc ratio in glaucoma patients receiving timolol monotherapy vis-a-vis timolol based dual therapies among timolol sub-optimal responders. Materials and Methods: After obtaining written informed consent and fulfilling the inclusion-exclusion criteria, fifty consecutive newly diagnosed cases of glaucoma or ocular hypertension with risk factors were recruited in the study. They received timolol eye drop up to 4th week. Participants not responding to timolol monotherapy optimally received either timolol plus brimonidine or timolol plus dorzolamide or timolol plus latanoprost for another 12 weeks. Participants responding optimally (at least 30% reduction of baseline) were continued with timolol monotherapy. Besides IOP changes, effects on visual field, visual acuity, cup disc ratio, safety, tolerability, and rate of persistency to therapy were studied. Results: Fifteen participants (30%) achieved target IOP reduction at 4 weeks of timolol monotherapy. All four treatment groups achieved significant IOP reduction (P < 0.001) from baseline to 16th week. Participants receiving timolol followed by timolol plus latanoprost had shown the highest IOP reduction at 16th week both from baseline and 4th week value (ANOVA test, P = 0.027, P = 0.000 respectively). No change in visual field or visual acuity or cup disc ratio was noticed. Adverse drug reactions observed were mild and mostly self limiting. Conclusion: Timolol and latanoprost combination might be a better choice in sub-optimal responders to timolol whereas it is wise to continue timolol monotherapy in optimally responders.

Seeking graduation in medical colleges outside India: Is it a ‘win–win’ or ‘lose–lose’ situation for the stakeholders and the nation?

The future of Indian students who return as ‘foreign medical graduates’ (FMG) after training in certain countries is often uncertain. We collected data from newspapers, government resources and agencies involved in handling this issue. We analysed the current status of medical education in India, the Commonwealth of Independent States (CIS) and some neighbouring countries. Of approximately 1.4 million (14 lakh) students taking the National Eligibility cum Entrance Test (NEET), about 5.8% get admission in medical colleges. There are about 554 medical colleges in India with 82 550 MBBS seats, 51.9% seats belong to the government quota. Parents who send their children to a foreign country to do medicine spend ?1.5 million (15 lakh) tò4 million (40 lakh) against an estimated annual income of ?1.2 million (12 lakh) and the child spends 4–6 years in a foreign country. Of 38 150 FMGs who took the examinations conducted by the National Board of Examinations from 2015 to 2018, 18.9% passed the FMG examination mandatory for registration to practise medicine in India. The National Medical Commission is trying to solve this issue by removing the age bar for entry to MBBS and recommending lowering of fees for MBBS in government quota. Seeking graduation in medical colleges outside India may not be advisable for those from the middle/ low-income group of India.

Acceleration of cutaneous wound healing by Lucilia sericata maggots in diabetic Wistar rats

@#The study was aimed to evaluate the effectiveness of maggot therapy in healing of cutaneous infected wound in streptozotocin (STZ) induced diabetic Wistar rat. For live maggots, the sterilized eggs of Lucilia sericata were obtained from colonies established in laboratory. Diabetes model was established in 48 male Wister rat by intra-peritoneal injection of STZ at the dose of 60 mg/kg body-weight. Cutaneous wounds exposed with mixed colonies of bacteria like Staphylococcus aureus, E. coli and Pseudomonas aeruginosa were prepared in all rat. The animals equally divided in 4 groups with 12 rats each being presented as treatment group of control, antibiotic, maggot and maggot with antibiotic in combination. All treatments were done once and hold for 24 hours. Wound kinetics and bacterial bio burden were measured at weekly interval to till complete healing. Significant reduction in wound area with maximum contraction was found (>95%) in maggot treated group when compared to antibiotic treated (79%) and control (72%). In maggot as well as maggot and antibiotic in combination group showed early elimination of bacterial bio-burden 7.88±0.03log CFU/ml to 1.12±0.65log CFU/ml and 7.86±0.04) log CFU/ml to 1.54±0.52log CFU/ml respectively in three weeks of time. Early healing indication was also experienced on histomorphological examination of wounded tissue of maggot treated groups by early and better epithelialization, collagenation and neovascularization with complete healing of wound in three weeks in comparison to antibiotic and control respectively. However, the present study did not show any difference in healing of wound with use of maggot alone or in antibiotic combination. Live maggot of Lucilia sericata effectively lower bacterial bioburden and and accelerate healing of infected cutaneous wound in diabetic conditions.

Therapeutic use of Lucilia sericata maggot in controlling bacterial bio-burden in Rat wound model

@#Delayed wound healing due to extraneous bacterial contamination, antibacterial resistance and other associated factors are of great concern in dealing patients having chronically infected wound. Medicinal properties of certain maggots of Calliphoridae family are known for its effective wound debridement therapy. The objective of the study was to evaluate the wound healing potential of maggots of Lucilia sericata in an experimentally infected cutaneous wound model in Wistar rat. The study was carried out by using male Wistar rats (n=48) by creating excisional wounds and later contaminated with mixed population of gram positive and gram-negative bacteria. Animals were divided randomly in to four groups with 12 individuals each, being denominated as control, antibiotic treated, maggot treated, and antibiotic plus maggot combination treated group. Ten pre-sterilized maggots were applied per centimetre square wound bed for 24 hours. Different wound kinetics in L. sericata maggot treated wounds revealed significant reduction in wound area with maximum contraction, early elimination of bacterial bioburden as compared to group of infected control and group of rats receiving only antibiotic treatment. The histopathological examination of wounded tissue of maggot treated groups showed early and better epithelialization, collagenation and neovascularization with complete healing of wound in two weeks. The maggot effects on healing when used singly or in combination with antibiotic were recorded to be similar. The results of the present study clearly demonstrate that the maggots of L. sericata possesses a definite antibacterial action along with removal of dead tissues and effectively reduced the bacterial bio-burden in infected wound and induced wound healing quickly.

Antimicrobial activity of leaf extract of Basilicum polystachyon (L) Moench.

Phenolic extract of leaves of Basilicum polystachyon (L) Moench was tested for in vitro antimicrobial activity against five bacteria (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Bacillus subtilis, Micrococcus leuteus) and three fungi (Fusarium oxysporum, Aspergillus niger, Helminthosporium oryzae). Efficacy of organic solvents, methanol and ethanol, as agents for extraction was compared with acidic water (2M; HCl). High-pressure liquid chromatographic (HPLC) data showed that acidic extraction (2M; HCl) resulted in higher yield of caffeic acid (0.437 mg g(-1)) and rosmarinic acid (0.919 mg g(-1)). Acidic extract showed high activity against Gram (+) ve bacteria, but was less active against Gram (-) ve bacteria. Amongst the tested fungi, maximum activity was exhibited against Aspergillus niger. This is the first report on the phenolic constituents and bioactivity of B. polystachyon.

Unusual presentation of schwannoma.

Schwannomas are slow growing benign tumours arising from the nerve sheath. Two cases of schwannoma arising from the vagus nerve are presented here. One case was found in a 6-year-old boy and another one in a 30-year-old man. In the first case the tumour was detected on the left side of the neck just below the angle of the mandible, and in the second case it was found on the lower part of the right side of the neck. Histopathology confirmed the diagnosis as first one to be of Antoni-A type and the second one to be of Antoni-B type. Both the tumours were excised and on follow-up the patients were doing well.

Colicinogenicity and enteropathogenicity of Escherichia coli associated with gastroenteritis in man.

Sixty strains of Escherichia coli, were isolated and identified from 94 samples of infantile diarrhoea and traveller's diarrhoea. Eleven strains were found to be colicinogenic and colicin 'H' was found to be predominant in conjunction with other colicins. Five strains were enteropathogenic of which 055 and one untypable strain were highly enteropathogenic. A positive correlation could be established between haemolytic character, dulcitol fermentation and the virulence of the strain involved.

Characterisation and identification of broad spectrum antibiotic producing Streptomyces hygroscopicus D 1.5.

A streptomycete strain D1.5 capable of producing broad spectrum antiobiotic was isolated from soil. The morphological, cultural, physiological and biochemical characters were studied, compared to known species and identified as Streptmoyces hygroscopicus. Antibiotic activity of the strain was tested against both Gram positive and negative bacteria as well as fungi. It exhibited complete resistance to beta-lactum antibiotics.

Effect of cimetidine on adenohypophysis of male albino mice under certain experimental condition.

Effect of 75 mg/kg of body weight of cimetidine administered intraperitoneally daily for 14 days to two groups of experimental animals (one of the experimental group was having intact testis and another group was bilaterally orchidectomized) was observed on cell population & cell volume of gonadotrophs and lactotrophs in pituitary gland, as it has not been studied earlier. In the experimental group of intact testis, there was significant reduction in the cell population of FSH cells in the cephalomedian area (P < 0.001) and in the lateral lobe (P < 0.01); the volume of both FSH and LH cells was also significantly reduced. In group 4 and group 5 there was significant increase in the population of lactotrophs and also in the volume of LH cells, FSH cells & lactotrophs. The change in the gonadotrophs in group 2 was due to increased production of testosterone from hypertrophied Leydig cells of testis rather then it's direct effect on adenohypophysis; in group 4 and group 5 the changes were due to lack of testosterone as in those cases bilaterally orchidectomy already done.

Effect of phenobarbitone on pituitary gland of male albino mice.

The effects of phenobarbitone on gonadotrophs and lactotrophs of pituitary gland were studied in male albino mice which were administered phenobarbitone 50 mg/kg body weight intraperitoneally (ip) daily for 14 days. A group of control mice were administered saline ip. In the experimental group, there was significant reduction in the average cell population of FSH cells in the cephalomedian area (P < 0.001) and in the lateral lobe (P < 0.01). The average volume of both FSH and LH cells was also significantly reduced (P < 0.001). The changes in the gonadotrophs of the experimental group could be attributed to the negative feedback action of testosterone which is being secreted from hypertrophied Leydig cells of testis.

Cord blood diazepam: clinical effects in neonates of eclamptic mothers.

Diazepam used in the treatment of eclampsia crosses the placental barrier readily, and may cause various clinical effects in the neonates. Twenty-five (25) live born babies of eclamptic mothers receiving diazepam were studied and cord blood diazepam concentration was estimated. Effect of low dose of diazepam is minimal apart from lowering of rectal temperature and the effects lasted for a period of 12 hours. But high dose (> 30 mg) of diazepam and prolonged duration of diazepam therapy in mothers causes significant depression of the newborn and the effects lasted for a period of 36-48 hours. As the clinical condition of the newborn is not related to the diazepam concentration in cord blood, the cord blood estimation is not helpful in the assessment of clinical effects of the drug in newborn. The tissue storage of the drug in newborn appears to be responsible for the clinical effects.