Intravascular Hemolysis, Methemogolbinemia and Acute Renal Failure in a Young Female.

Copper sulfate occurs as large blue crystals in nature, commonly known as "blue vitriol" or "blue stone." It is a potentially lethal poison with significant mortality. Copper sulfate is a powerful oxidizing agent and causes corrosive injury to the mucous membrane. The clinical course involves intravascular hemolysis resulting in anemia, jaundice, and renal failure. Laboratory diagnosis of the condition is not an issue; the difficulty is suspecting it, promptly initiating chelation therapy, and other supportive symptomatic treatment. We present a case of copper sulfate poisoning in a young female with suicidal intent resulting in severe acute toxicity, which was successfully managed by copper chelator (d-Penicillamine) and other supportive measures.

Withania somnifera (L.) Dunal whole-plant extracts exhibited anti-sporotrichotic effects by destabilizing peripheral integrity of Sporothrix globosa yeast cells.

Chronic topical cases of Sporotrichosis, a chronic fungal infection caused by the ubiquitously present cryptic members of the Sporothrix species complex, are treated with oral administrations of itraconazole. However, severe pulmonary or disseminated cases require repeated intra-venous doses of amphotericin B or even surgical debridement of the infected tissue. The unavoidable adverse side-effects of the current treatments, besides the growing drug resistance among Sporothrix genus, demands exploration of alternative therapeutic options. Medicinal herbs, due to their multi-targeting capacity, are gaining popularity amidst the rising antimicrobial recalcitrance. Withania somnifera is a well-known medicinal herb with reported antifungal activities against several pathogenic fungal genera. In this study, the antifungal effect of the whole plant extract of W. somnifera (WSWE) has been explored for the first time, against an itraconazole resistant strain of S. globosa. WSWE treatment inhibited S. globosa yeast form growth in a dose-dependent manner, with IC50 of 1.40 mg/ml. Minimum fungicidal concentration (MFC) was found to be 50 mg/ml. Sorbitol protection and ergosterol binding assays, revealed that anti-sporotrichotic effects of WSWE correlated well with the destabilization of the fungal cell wall and cell membrane. This observation was validated through dose-dependent decrease in overall ergosterol contents in WSWE-treated S. globosa cells. Compositional analysis of WSWE through high performance liquid chromatography (HPLC) exhibited the presence of several anti-microbial phytochemicals like withanone, withaferin A, withanolides A and B, and withanoside IV and V. Withanone and withaferin A, purified from WSWE, were 10-20 folds more potent against S. globosa than WSWE, thus, suggesting to be the major phytocompounds responsible for the observed anti-sporotrichotic activity. In conclusion, this study has demonstrated the anti-sporotrichotic property of the whole plant extract of W. somnifera against S. globosa that could be further explored for the development of a natural antifungal agent against chronic Sporotrichosis.

Differential outcomes for frontal versus posterior demyelination in childhood cerebral adrenoleukodystrophy.

In the most common variant of childhood cerebral adrenoleukodystrophy (cALD), demyelinating brain lesions are distributed predominately in parieto-occipital white matter. Less frequently, lesions first develop in frontal white matter. This matched cohort study examined whether outcomes after standard treatment with hematopoietic cell transplantation (HCT) differ in patients with early stage frontal lesions as compared to parieto-occipital lesions. Retrospective chart review identified seven pediatric patients with frontal cALD lesions and MRI severity score < 10 who underwent a single HCT at our center between 1990 and 2019. Concurrent MRI, neurocognitive and psychiatric outcomes at last comprehensive follow-up (mean 1.2 years; range 0.5-2.1 years) were compared with a group of seven boys with the parieto-occipital variant matched on pre-HCT MRI severity score. Both groups showed similar rates of transplant complications and radiographic disease advancement. Neurocognitive outcomes were broadly similar, with more frequent working memory deficits among individuals with frontal lesions. Psychiatric problems (hyperactivity, aggression, and atypical behavior) were considerably more common and severe among patients with frontal lesions. Aligned with the critical role of the frontal lobes in emotional and behavioral regulation, functional disruption of self-regulation skills is widely observed among patients with frontal lesions. Comprehensive care for cALD should address needs for psychiatric care and management.

Impact of Yoga on Mental Health and Sleep Quality Among Mothers of Children With Intellectual Disability.

OBJECTIVES: Caring for a child with Intellectual Disability Disorder (IDD) is a tremendously stressful task for any mother, leading to poor mental health and compromised quality of life. Anxiety, depression, stress, and poor sleep quality are frequently observed in mothers with Intellectual Disability Disorder child. This study assessed the impact of a 1-month yoga intervention on anxiety, depression, stress and sleep quality in mothers of children with intellectual disabilities. METHODS: We selected 53 mothers of children with intellectual disabilities between the age of 30 and 50 years (mean age, 40.2 ± 7.1 years). Of these mothers, 28 received 1.5 hours of integrated yoga practice consisting of physical postures, breathing techniques, relaxation techniques and meditation every other day for 1 month. The remaining 25 mothers, who served as the control group, participated in a group discussion session twice a week for 1 month. MAIN OUTCOME MEASURES: All mothers were assessed for anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), stress with the Perceived Stress Scale (PSS), and sleep quality with the Pittsburgh Sleep Quality Index (PSQI) at baseline and at 1 month. RESULTS: Significant improvements in anxiety (-24.8%; P < .001), depression (-15.9%; P < .001), sleep quality (-25.1%; P < .05) and stress (-11.4%; P < .001) were observed after 1 month compared with baseline in the yoga group. In a similar fashion, a significant decrease in anxiety (-12.3%; P < .001), depression (-8.6%; P < .001) and sleep quality (-5.6%; P < .001) was seen in the control group as well. The between-group comparison of post-intervention scores revealed a significantly better improvement in anxiety (P <.001), depression (P < .001), perceived stress (P < .001) and sleep quality (P = .012) in the yoga group compared with the control group. CONCLUSIONS: Our study indicates that yoga can be used as an effective intervention to improve psychopathology and sleep quality in mothers of children with intellectual disabilities. We recommend future randomized controlled trials with larger sample sizes and of longer duration to study the long-term effects of yoga.

Proximal and contextual correlates of childhood stunting in India: A geo-spatial analysis.

BACKGROUND: Globally, India is home to every third child affected by stunting. While numerous studies have examined the correlates of childhood stunting (CS) in India, most of these studies have focused on examining the role of proximal factors, and the role of contextual factors is much less studied. This study presents a comprehensive picture of both proximal and contextual determinants of CS in India, expanding the current evidence base. The present study is guided by the WHO conceptual framework, which outlines the context, causes, and consequences of CS. DATA AND METHODS: The study used exploratory spatial data analysis tools to analyse the spatial pattern and correlates of CS, using data from the fourth round (2015-16) of the National Family Health Survey (NFHS-4) and the 2011 Census of India. RESULTS: The study findings reiterate that CS continues to be high in India, with several hot spot states and districts, and that children from the central and eastern region of the nation, namely, Bihar, Jharkhand, Madhya Pradesh, and Uttar Pradesh are particularly vulnerable. Our analysis has identified six risk factors-maternal short stature, large household size, closely spaced births, prevalence of hypertension among women, household poverty, open defecation, and extreme temperature-and four protective factors-female education, access to improved drinking water, dietary diversity among children, and iron and folic acid (IFA) supplementation during pregnancy. CONCLUSIONS: The study highlights the need for investing in pre-conception care, addressing both demand- and supply-side barriers to increase the coverage of nutrition-specific interventions, implementing programmes to promote the intake of healthy foods from an early age, providing contraceptive counselling and services to unmarried and married adolescents and young women and men, and universalizing quality primary and secondary education that is inclusive and equitable to avert the burden of childhood stunting in India.

Parental knowledge and common practices regarding acute respiratory infections in children admitted in a hospital in rural setting.

CONTEXT: In developing countries, there is paucity of data regarding knowledge and practices of parents regarding acute respiratory infections (ARIs). AIMS: The present study was undertaken to study the knowledge and practices of parents for ARIs. SETTINGS AND DESIGN: This was a prospective, cross-sectional study conducted over period of 3 months in pediatric ward of a tertiary care teaching hospital. SUBJECTS AND METHODS: All the children admitted in pediatrics ward with complaints of ARI were included in the study. STATISTICAL ANALYSIS USED: Statistical analysis was carried out by using Statistical Package for Social Sciences software version 20. RESULTS: A total of 1,752 children were enrolled in the study out of which 885 (50.51%) were males and 867 (49.49%) were females. Only 42.6% of parents answered correct answers about the proper use of antibiotics for children with ARI. Most of the caregivers (58.4%) had poor knowledge about incomplete immunization as a risk factor for developing diseases like diphtheria and pertussis. Majority of caregivers (66.3%) practice home remedies by themselves. CONCLUSION: The knowledge of caregivers/parents regarding symptoms, risk factors, and complications of ARI was adequate. Better awareness is needed for safe use of antibiotics, and caregivers shall be encouraged to minimize indoor air pollution. More awareness is required for discouraging the practice of visiting quacks as it can lead to serious complications in the child.

A comprehensive review of the bioenergetics of fatty acid and glucose metabolism in the healthy and failing heart in nondiabetic condition.

The function of the heart is defined by its ability to deliver adequate cardiac output to meet the requirements of the body both at rest and with exertion. To fill this role, the heart demonstrates an impressive capacity to tightly regulate energy generation and consumption. Energy production and transfer within cardiac myocytes primarily relies on the process of oxidative phosphorylation. In the failing heart, there is an imbalance between the work of the cardiac system and the energy required to generate this work. This presence of this mismatch has given rise to the concept known as the energy starvation theory. This concept encapsulates observations such as perturbed substrate consumption, insufficient energy transfer and ingestion, reduced substrate and oxygen availability, and diminished energy production in the failing heart. Diminished available cellular energy may further result from a reduction in the biosynthesis of mitochondria and their protein synthesis and from global cellular architectural disarray. In essence, the energy starvation theory posits that cardiac pump function declines due to a reduction in oxygen and substrate availability, and thus leads to a total body starvation of systemic energy. This novel cognitive framework has led to encouraging new directions in a "metabolic therapeutic approach" for the failing heart.

Antagonist molecules in the treatment of angina.

INTRODUCTION: Management of chronic angina has evolved dramatically in the last few decades with several options for pharmacotherapy outlined in various evidence-based guidelines. AREAS COVERED: There is a growing list of drugs that are currently being investigated for treatment of chronic angina. These also include several herbal medications, which are now being scientifically evaluated as potential alternative or even adjunctive therapy for angina. Gene- and cell-based therapies have opened yet another avenue for management of chronic refractory angina in 'no-option' patients who are not candidates for either percutaneous or surgical revascularization and are on optimal medical therapy. An extensive review of literature using PUBMED, Cochrane database, clinical trial databases of the USA and European Union was done and summarized in this review. This review will attempt to discuss the traditional as well as novel therapeutic agents for angina. EXPERT OPINION: Several pharmacological and non-pharmacological therapeutic options are now available for treatment and management of chronic refractory angina. Renewed interest in traditional therapies and cell- and gene-based modalities with targeted drug delivery systems will open the doors for personalized therapy for patients with chronic refractory angina.

Efficacy of Withania somnifera on seminal plasma metabolites of infertile males: a proton NMR study at 800 MHz.

ETHNOPHARMACOLOGICAL RELEVANCE: Traditional Indian systems of medicine use roots of Withania somnifera for impotence, infertility treatment, stress, and the aging process. Although Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress, the molecular mechanism is not clear. AIM OF THE STUDY: Our study uses high-resolution Nuclear Magnetic Resonance (NMR) spectroscopy to explore the scientific basis to reveal the pre- and post-treatment efficacy of Withania somnifera on seminal plasma of infertile men-which remains unexplored to date. MATERIALS AND METHODS: A total of 180 infertile male patients were administered Withania somnifera root powder at the rate of 5 g/d for a 3-month period. The study included age-matched, healthy men as a control (n=50) group. Proton NMR spectroscopy was used to measure lactate, alanine, glutamate, glutamine, citrate, lysine, choline, glycerophosphocholine (GPC), glycine, tyrosine, histidine, phenylalanine, and uridine in all seminal plasma samples. To appraise infertility levels, we also measured sperm concentration, motility, lipid peroxide, and hormonal perturbation. RESULTS: Withania somnifera therapy repairs the disturbed concentrations of lactate, alanine, citrate, GPC, histidine, and phenylalanine in seminal plasma and recovers the quality of semen of post-treated compared to pre-treated infertile men. Serum biochemistry was also improved over post-therapy in infertile men. Our findings reveal that Withania somnifera not only reboots enzymatic activity of metabolic pathways and energy metabolism but also invigorates the harmonic balance of seminal plasma metabolites and reproductive hormones in infertile men. CONCLUSION: The results suggest that Withania somnifera may be used as an empirical therapy for clinical management and treatment of infertility.

Inhibition of adherence of multi-drug resistant E. coli by proanthocyanidin.

Proanthocyanidin is commonly used for inhibiting urinary tract infection (UTI) of sensitive strains of Escherichia coli. The aim of this study was to investigate the effect of proanthocyanidin on adherence of uropathogenic multi-drug resistant E. coli to uroepithelial cells, which has not yet been investigated so far. Extracts of the purified proanthocyanidin were prepared from dried cranberry juice. Purity and structural assignment of proanthocyanidin was assessed using high performance liquid chromatography and (13)C nuclear magnetic resonance spectroscopy, respectively. Subsequently, its affect on multi-drug resistant bacteria as well as quantification of anti-adherence bioactivity on human vaginal and bladder epithelial cells was appraised. Inhibition of adherence to an extent of about 70% with multi-drug resistant E. coli strains was observed on uroepithelial cell. The anti-adherence bioactivity of the proanthocyanidin was detected at concentrations of 10-50 µg/ml with significant bacteriuria. Probable proanthocyanidin through A-type linkages either combines to P-fimbriae of bacterial cells or modifies the structural entity of P-fimbriae and inhibits bacterial adherence to uroepithelial cells. The proanthocyanidin exhibited anti-adherence property with multi-drug resistant strains of uropathogenic P-fimbriated E. coli with in vitro study. Hence proanthocyanidin may be considered as an inhibitory agent for multi-drug resistant strains of E. coli adherence to uroepithelial cells.

A proton NMR study of the effect of Mucuna pruriens on seminal plasma metabolites of infertile males.

The objective of this study was to employ proton nuclear magnetic resonance ((1)H NMR) spectroscopy to evaluate the impact of Mucuna pruriens seeds on the metabolic profile of seminal plasma of infertile patients. A total of 180 infertile patients were administered M. pruriens seed powder for a period of three months. Age-matched healthy men comprised the control (n=50) group in the study. Lactate, alanine, choline, citrate, glycerophosphocholine (GPC), glutamine, tyrosine, histidine, phenylalanine, and uridine were measured in seminal plasma by (1)H NMR spectroscopy. To evaluate the degree of infertility and extent of hormonal imbalance induced by this milieu, separate sperm concentration, motility, lipid peroxide in seminal plasma and LH, FSH, T, and PRL hormone concentration in serum were measured using standard laboratory methods and RIA, respectively, in the same subjects. M. pruriens therapy rectifies the perturbed alanine, citrate, GPC, histidine and phenylalanine content in seminal plasma and improves the semen quality of post-treated infertile men with compared to pre-treated. Concomitantly, clinical variables in seminal plasma and blood serum were also improved over post therapy in infertile men. On the basis of these observations, it may be proposed that M. pruriens seed powder not only reactivates the enzymatic activity of metabolic pathways and energy metabolism but also rejuvenates the harmonic balance of male reproductive hormones in infertile men. These findings open more opportunities for infertility treatment and management by improving semen quality.

Changing trends of in vitro antimicrobial resistance patterns in blood isolates in a tertiary care hospital over a period of 4 years.

CONTEXT: Multidrug-resistant organisms continue to be a problem for clinicians worldwide. AIMS: To analyze the changing trend of antimicrobial susceptibility patterns in the blood isolates over a period of 4 years in our hospital. SETTINGS AND DESIGN: This is a retrospective study done in tertiary care cardiac institute over a period of 4 years. MATERIALS AND METHODS: We retrospectively analyzed blood culture positive isolates and studied the antimicrobial susceptibility patterns of microorganisms during the period starting from January 2007 to December 2010. STATISTICAL ANALYSIS USED: Statistical analysis was conducted using SPSS for windows version 13.0. Fisher exact test or chi-square test was applied for comparison of categorical variables. P values less than .05 were considered as statistically significant. RESULTS: The rate of blood culture positivity was 3.72%. Gram-negative bacteria were more common than Gram-positive bacteria. There was a gradual increase in Gram-negative bacteria especially Klebsiella pneumoniae and Acinetobacter species. Klebsiella pneumoniae showed a significant increase of resistance to cefoperazone sulbactam (P = .023), piperacillin tazobactam (P < 0.001), imipenem (P < 0.001), and meropenem (P < 0.001) between the first (2007-2008) and second period (2009-2010) of study. The carbapenems resistance is on rise in Gram-negative bacteria including Enterobacteriaceae and non-fermenters. CONCLUSIONS: Our findings suggest that there is a definite increase in the multidrug resistant organisms. The data on the changing trends in antibiotic resistance, we believe is an important pillar in our efforts at improving infection control practices.