Image-guided synovial biopsy with a focus on infection.

Image-guided biopsy of the synovium is a relatively uncommon but safe procedure with a high-diagnostic yield in the correct clinical scenario. Whilst surgical and arthroscopic techniques are still commonly performed and remain the gold standard, they are more invasive, expensive and not widely available. Ultrasound and X-ray-guided synovial biopsy are being increasingly performed by radiologists to diagnose both native and periprosthetic joint infection (PJI) to guide surgical and microbiological management. The purpose of this review article is to present the historical background to synovial biopsy particularly related to potential joint infection, including common and uncommon pathogens encountered, sampling techniques and pitfalls, focusing mainly on its role in PJI and its role in patient pathways and decision-making within a joint infection multi-disciplinary framework.

Red cell alloimmunization among antenatal women attending tertiary care center in Jamnagar, Gujarat, India.

BACKGROUND: The following study was conducted to measure the presence of alloantibodies of Rh and other blood group antigens produced due to fetomaternal hemorrhage in all antenatal women as well as those leading to hemolytic disease of fetus and newborn; presenting to a tertiary care center, G.G. Government Hospital, Jamnagar, Gujarat, India, between April 2014 and March 2016 (2 years). MATERIALS AND METHODS: All multiparous women irrespective of their period of gestation or obstetrics history were included whereas those having taken anti-D immunoprophylaxis or with a history of blood transfusion were excluded. Antibody screening and identification were done using Bio-Rad ID microtyping system. RESULTS: Out of total 8920 multigravida females, 8488 were D-antigen positive whereas 432 were D-antigen negative. A total of 126 antibodies among 117 females (1.31%) were found; out of them, 33 were found in D-antigen positive females (0.39%) and 84 in D-antigen negative ones (19.44%) looking at overall frequency of other antibodies such as anti-C: 9, anti-c: 9, anti-E: 13, anti-Cw: 1, anti-M: 5, anti-S: 8, anti-Fya: 3, and anti-D: 78; it was found that anti-D is the most common. CONCLUSION: The rate of alloimmunization in D-antigen negative women was found to be very high as compared to other studies in western region; hence, strict follow-up of immunoprophylaxis of all Rh D-negative women needs to be taken care of. Apart from this, D-antigen-positive women also show alloimmunization against various antigens giving the prevalence of 0.39%; hence, it should be mandatory that there should be one standard universal protocol for screening of all antenatal women.

Molecular Epidemiology and Antigenic Characterization of Seasonal Influenza Viruses Circulating in Nepal.

BACKGROUND: Influenza is one of the public health burdens in Nepal and its epidemiology is not clearly understood. The objective of this study was to explore the molecular epidemiology and the antigenic characteristics of the circulating influenza viruses in Nepal. METHODS: A total of 1495 throat swab specimens were collected from January to December, 2014. Real time PCR assay was used for identification of influenza virus types and subtypes. Ten percent of the positive specimens were randomly selected and inoculated onto Madin-Darby Canine Kidney Epithelial cells (MDCK) for influenza virus isolation. All viruses were characterized by the hemagglutination inhibition (HI) assay. RESULTS: Influenza viruses were detected in 421/1495 (28.2%) specimens. Among positive cases, influenza A virus was detected in 301/421 (71.5%); of which 120 (39.9%) were influenza A/H1N1 pdm09 and 181 (60.1%) were influenza A/H3 subtype. Influenza B viruses were detected in 119/421 (28.3%) specimens. Influenza A/H1N1 pdm09, A/H3 and B viruses isolated in Nepal were antigenically similar to the vaccine strain influenza A/California/07/2009(H1N1pdm09), A/Texas/50/2012(H3N2), A/New York/39/2012(H3N2) and B/Massachusetts/2/2012, respectively. CONCLUSIONS: Influenza viruses were reported year-round in different geographical regions of Nepal which was similar to other tropical countries. The circulating influenza virus type and subtypes of Nepal were similar to vaccine candidate virus which could be prevented by currently used influenza vaccine.

Characterization of Seasonal Influenza Virus Type and Subtypes Isolated from Influenza Like Illness Cases of 2012.

Background Seasonal influenza is one of the increasing public health burdens in Nepal. Objective The objective of this study was to isolate and characterize the influenza virus type and subtypes of Nepal. Method A total of 1536 throat swab specimens were collected from January to December 2012. Total ribonucleic acid was extracted using Qiagen viral nucleic acid extraction kit and polymerase chain reaction assay was performed following the US; CDC Real-time PCR protocol. Ten percent of positive specimens were inoculated onto Madin-Darby Canine Kidney cells. Isolates were characterized by using reference ferret antisera. Result Of the total specimens (n=1536), influenza virus type A was detected in 196 (22%) cases; of which 194 (99%) were influenza A (H1N1) pdm09 and 2 (1 %) were influenza A/H3 subtype. Influenza B was detected in 684 (76.9%) cases. Influenza A (H1N1) pdm09, A/H3 and influenza B virus were antigenically similar to the recommended influenza virus vaccine candidate of the year 2012. Although sporadic cases of influenza were observed throughout the year, peak was observed during July to November. Conclusion Similar to other tropical countries, A (H1N1) pdm09, A/H3 and influenza B viruses were co-circulated in Nepal.

The imaging of neuroendocrine tumors using single photon emission computed tomography/computed tomography.

There have been several advances in technology over the past decade with the advent of hybrid imaging having a large impact on nuclear medicine, first with PET/CT and then more recently with SPECT/CT. Initial SPECT/CT systems used low dose but very low quality CT and except for attenuation correction offered no great advantage over reviewing SPECT and CT images side by side. More recently hybrid machines have become available and a series of studies have shown improved accuracy compared to SPECT alone with resulting changes in patient management. This has been true not only with somatostatin analogue imaging but also for demonstrating amine uptake using MIBG. Whilst PET/CT may be seen as the ideal, this may be less accessible due to the high cost and limited availability. In this case hybrid SPECT/CT offers hope for providing high quality and accurate imaging of neuroendocrine tumors.

Histochemical detection of steroid synthesizing cells in the testes of goldfish, Carassius auratus, during the annual reproductive cycle.

We investigated the sites of Δ(5)-3ß-hydroxysteroid dehydrogenase (3 ß-HSD) and glucose-6-phosphate dehydrogenase (G-6-PD) synthesis in the testes of goldfish, Carassius auratus, during the annual reproductive cycle. The histochemistry of fish gonads has been investigated previously in many species other than goldfish. The reproductive cycle of goldfish, is divided into five stages and the steroid synthesizing cells of the testes were studied during these stages, using histochemical techniques. We found that interstitial cells and seminiferous tubules are the main steroid synthesizing sites in testes of goldfish, and that enzyme activity was more intense in the interstitial cells than in the seminiferous tubules. During the pre-spawning months, 3 ß-HSD and G-6-PD activities were weak compared to the spawning months.

Immunomodulating and antiproteinuric effect of Hippophae rhamnoides (Badriphal) in idiopathic nephrotic syndrome.

OBJECTIVE: The treatment of idiopathic nephrotic syndrome is still not well settled and at times is very frustrating. Number of protocols have been reported with variable results outcome in various conditions. The main pillar of treatment of idiopathic nephrotic syndrome is use of immunomodulating and suppressive drugs in various combinations. The herbal preparations have also been reported to have immunomodulating property. The study has been planned to record Immunomodulating and antiproteinuric effect of Hippophae rhamnoides. MATERIAL AND METHODS: In the present study had 2 groups having 28 patients of idiopathic nephrotic syndrome in each group have been included. The patients were subjected to haematological, biochemical, immunological investigation at 0, 1, 2 and 3 months interval with dietic advise. Group A have been put on standard treatment, whereas group B on Badriphal in the well worked up doses. The hydroalcoholic extract of 350 mg twice daily of Badriphal was given to group B as add on treatment. Patients were followed up with definite protocol at monthly interval for 3 months. RESULTS: At the end of 3 month patients showed improvement in the symptoms of oedema, anorexia, oliguria in the herbal group. The urinary estimation of protein showed significant decrease in Group B with elevation of S. albumin levels. The inflammatory cytokines has showed significant decrease at the end of 3 month. CONCLUSION: Thus the pilot study showed beneficial effect of the herbal preparation Hippophae rhamnoides as add on treatment. A large perspective study is recommended to establish these findings.

Molecular diversity analysis of Rhizoctonia solani isolates infecting various pulse crops in different agro-ecological regions of India.

Genetic diversity of 89 isolates of Rhizoctonia solani isolated from different pulse crops representing 21 states from 16 agro-ecological regions of India, 49 morphological, and 7 anastomosis groups (AGs) was analyzed using 12 universal rice primers (URPs), 22 random amplified polymorphic DNA (RAPD), and 23 inter-simple sequence repeats (ISSR) markers. Both URPs and RAPD markers provided 100 % polymorphism with the bands ranging from 0.1 to 5 kb in size, whereas ISSR markers gave 99.7 % polymorphism with the bands sizes ranging from 0.1 to 3 kb. The marker URP 38F followed by URP13R, URP25F, and URP30F, RAPD marker R1 followed by OPM6, A3 and OPA12 and ISSR3 followed by ISSR1, ISSR4, and ISSR20 produced the highest number of amplicons. R. solani isolates showed a high level of genetic diversity. Unweighted pair group method with an arithmetic average (UPGMA) analysis grouped the isolates into 7 major clusters at 35 % genetic similarity using the three sets of markers evaluated. In spite of using three different types of markers, about 95 % isolates shared common grouping patterns. The majority of the isolates representing various AGs were grouped together into different sub-clusters using all three types of markers. Molecular groups of the isolates did not correspond to agro-ecological regions or states and crops of the origin. An attempt was made for the first time in the present study to determine the genetic diversity of R. solani populations isolated from different pulse crops representing various AGs and agro-ecological regions.

Pandemic (H1N1) 2009 cases in Nepal.

We analyzed the data available in Nepal during this pandemic in order to determine the epidemiological, clinical and virological characteristics of pandemic influenza A in 2009. The test was conducted by real-time Reverse Transcription--Polymerase Chain Reaction on sample from patients with suspected influenza-like illnesses. Out of 538 cases were tested, 32% were positive for pandemic influenza A 2009 and the infection rate was highest for cases of 11-20 years and lowest in >50 years of age.

Lack of correlation between BCG-induced tuberculin skin test sensitisation and protective immunity in cattle.

Vaccination of cattle with Mycobacterium bovis Bacille Calmette-Guérin (BCG) can provide significant protection against bovine tuberculosis (TB). However, BCG vaccination sensitises animals to respond to the tuberculin skin-test. This provides a potential operational impediment to the use of BCG as a cattle vaccine since the tuberculin skin-test is the primary surveillance tool used by many countries with 'test and slaughter' control strategies. Currently, it is also unclear what BCG-induced skin-test conversion means in respects to BCG's protective immunity. In the current study we first investigated the duration of tuberculin skin-test sensitisation in calves neonatally vaccinated with BCG. BCG vaccination induced strong skin-test responses in calves during their first 6 months. However, a rapid decay in skin-test sensitivity was observed after this time. Between 6 and 9 months this represented a reduction from 80% to 8% of calves providing a positive response in the single intradermal comparative cervical tuberculin test at standard interpretation. We next investigated the relationship between BCG induced skin-test sensitivity and retention of protective immunity. Calves were neonatally vaccinated with BCG and subsequently divided into 2 groups based on retention or loss of tuberculin skin-test responses after 6 months. In contrast to their skin-test responsiveness, these vaccinates maintained their tuberculin specific IFN-γ blood responses. Moreover, irrespective of their pre-challenge skin-test responses, following M. bovis challenge both groups of BCG vaccinated calves demonstrated comparable levels of protection, as evidenced by reduced TB-associated pathology. Therefore, we have demonstrated that following neonatal BCG vaccination of cattle, tuberculin skin-test responder frequencies waned rapidly after 6 months but importantly, loss of skin-test sensitivity did not correlate with loss of protective immunity. These findings could have implications for the practical application of BCG based cattle vaccines.

Clinical evaluation of Kushmanda Ghrita in the management of depressive illness.

Depressive illness has been considered as a problematic mental illness since antiquity. The treatment modalities of depressive illness are of many kinds. Use of Medhya Rasayana drugs is a unique method of treatment described in Ayurveda for depressive illness. Kushmanda (Benincasa hispida) is one of the Medhya Rasayana as described by Bhava Mishra. Ghrita is also considered as Medhya Rasayana by almost all Acharyas. Keeping this background Kushmanda Ghrita has been selected as a trial drug to treat the patients of depressive illness. The study was carried out in 35 clinically diagnosed cases of depressive illness by using DSM-IV diagnostic criteria of depressive illness. All patients were given 20 ml of Kushmanda Ghrita in two divided doses morning and evening with 40 ml of lukewarm water for a period of one month. It has shown statistically significant results with psychometric parameters-Hamilton depression rating scale (t = 24.36, P < 0.001), Hamilton anxiety rating scale (t = 26.20, P < .001), immediate memory span direct (t = 4.35, P < 0.001), and indirect test (t = 3.43, P < 01) along with clinical symptoms.

A clinical study on the effect of Rishyagandha (Withania coagulans) in the management of Prameha (Type II Diabetes Mellitus).

The study was conducted with an objective of evaluating the role of Rishyagandha (Withania coagulans) powder in clinically diagnosed cases of Prameha. 53 Registered cases were divided into 3 groups; Group A (Rishyagandha fruits powder), Group B (Oral Hypoglycaemic Agent i.e. OHA), and Group C (Rishyagandha fruits powder and OHA both). Statistically significant improvement was observed in objective and subjective parameters in all 3 groups after completion of the course of treatment. Based on the results, it has been concluded that, Rishyagandha fruits powder is an effective therapeutic regimen in the management of uncomplicated cases of Prameha.

Resistotypes of Vibrio cholerae 01 Ogawa Biotype El Tor in Kathmandu, Nepal.

Cholera continued to be a major diarrheal illness in Nepal and antibiotic resistance has appeared as a serious problem in cholera management. The study aimed at analyzing the distribution pattern of the resistotypes (R-types) of Vibrio cholerae in the Kathmandu valley, Nepal. During June 2008 to January 2009, 210 diarrheal specimens received at National Public Health Laboratory from suspected cholera patients were subjected to standard bacteriological investigation including biotyping and serotyping. Antimicrobial susceptibility pattern of V. cholerae isolates was determined by Kirby Bauer disc diffusion method following CLSI guidelines. A total of 57 (27%) V. cholerae isolated were recovered, all of which belonged to 01 Ogawa Biotype EL Tor. Based on antibiogram, V. cholerae isolates in our study revealed three distinct R-types: R-type I, R-type II and R-type III. All three R types showed resistance to furazolidone, nalidixic acid and cotrimoxazole while sensitive to ciprofloxacin and tetracycline. Additional resistance to ampicillin and erythromycin was observed respectively in R-type II and III. Different R-types showed unique month wise variations (P < 0.05). Differentiation of V. cholerae strains into R-types is an important tool. In addition to direct patient management, it may have implication in identifying the source and spread of infection, and understanding the distribution pattern in a particular geographical region.

Prevalence of touch sensation (sparshanendriya-vyapaktva).

There are much more topics in our Ayurvedic classics about which we have limited knowledge. Like this an another topic is Indriya. We don't know what is indriya or what are their sites. Are the organs by which we perceive sensation called Indriya or different from them? Acharya Charaka has told five types of Indriyas, Sparshanendriya, Chakshurendriya, Ghranendriya, Rasanendriya & Shravanendriya. He also described their sites, functions, composition, and their properties. But he also told that Sparshanendriya is the main Indriya and it is present in all Indriyas. Why Charaka told that Sparshanendriya is Vyapak in all Indriyas. Is this concept wrong or right? The answer is right & this concept can be proved by following means as described in this paper.

Traditional uses of medicinal plants among the rural communities of Churu district in the Thar Desert, India.

The traditional uses of medicinal plants in healthcare practices are providing clues to new areas of research; hence its importance is now well recognized. However, information on the uses of indigenous plants for medicine is not well documented from many rural areas of Rajasthan including Churu district. The study aimed to look into the diversity of plant resources that are used by local people for curing various ailments. Questionnaire surveys, participatory observations and field visits were planned to elicit information on the uses of various plants. It was found that 68 plant species are commonly used by the local people for curing various diseases. In most of the cases (31%) leaves were used. The interviewees mentioned 188 plant usages. Those most frequently reported had therapeutic value for treating fever, rheumatism, diarrhea, asthma and piles. The knowledge about the total number of medicinal plants available in that area and used by the interviewees was positively correlated with people's age, indicating that this ancient knowledge tends to disappear in the younger generation.

Studies on differential sensing of dopamine at the surface of chemically sensitized ormosil-modified electrodes.

We report herein the preparation of few chemically sensitized organically modified sol-gel glass (ormosil) films and sensing of dopamine at the surface of the modified electrodes derived from these films. The chemical sensitization in ormosil-modified electrodes is introduced by incorporating: (a) potassium ferricyanide and (b) either Nafion, or dibenzo-18-crown-6 or in situ generated Prussian blue from potassium ferricyanide. Electrochemical sensing of dopamine on the surfaces of these modified electrodes have been investigated and found that: (i) the presence of dibenzo-18-crown-6 facilitate the magnitude of dopamine sensing, (ii) conversion of potassium ferricyanide into Prussian blue also enhances the magnitude of dopamine sensing as compared to that of control and Nafion sensitized modified electrodes, (iii) both dibenzo-18-crown-6 and Nafion sensitized ormosil-modified electrodes are found selective to dopamine in the presence of ascorbic acid present under physiological concentration range. These finding again directed our attention to investigate the sensing of dopamine: (a) on dibenzo-18-crown-6 incorporated within Prussian blue sensitized modified electrode and (b) in the presence of varying concentrations of dibenzo-18-crown-6 in the Prussian blue modified electrodes. The investigations made on these lines again suggested the following: (1) increase in dibenzo-18-crown-6 concentrations in the modified electrode increases the magnitude of dopamine sensing upto an optimum concentration of macrocycle; (2) the detection limit of dopamine sensing goes down to 30nM as compared to that of dibenzo-18-crown-6 incorporated with potassium ferricyanide which was found to the order of 100nM. Investigations of the interference of ascorbic acid revealed that the presence of dibenzo-18-crown-6 introduces selectivity in dopamine sensing in the presence such common interfering analyte like ascorbic acid.

Role of palladium in the redox electrochemistry of ferrocene monocarboxylic acid encapsulated within ORMOSIL networks.

We report herein the effect of palladium on the redox electrochemistry of ferrocene monocarboxylic acid encapsulated within an organically modified sol-gel glass network (ORMOSIL). It has been found that amount of palladium and its geometrical distribution significantly alter the redox electrochemistry of FcMCA. The geometrical distribution of palladium has been controlled by two methods: (i) palladium is allowed to link within nanostructured network of the ORMOSIL which was subsequently availed from the reactivity of palladium chloride and trimethoxysilane; (ii) palladium powder is encapsulated together FcMCA thus allowing the presence of palladium within the nanoporous domain. The content of palladium is varied by controlling the reaction dynamics of palladium chloride and trimethoxysilane interaction. For this we initially allowed to trigger hydrolysis, condensation and poly-condensation of trimethoxysilane and dimethyldiethoxysilane in acidic medium and subsequently partially dried ORMOSIL film was allowed to interact with palladium chloride. Even with partially dried ORMOSIL derived from trimethoxysilane and dimethyldiethoxysilane undergoes rapid interaction with palladium chloride and the transparent color of ORMOSIL changed to a black colour due to the formation of palladium silicon linkage. The palladium-silicon linkage has been identified by NMR, UV-VIS and transmission electron spectroscopy. The electrochemistry of FcMCA encapsulated within such an ORMOSIL matrix has been studied. Excellent redox electrochemistry of ferrocene monocarboxylic acid having peak potential separation tending to 0 for a multilayered electrode was investigated. The palladium content has been found to affect the redox electrochemistry of ferrocene as well as electrocatalytic efficiency of new ORMOSIL material. The electroanalysis of NADH is reported. The modified electrode is very sensitive to NADH with lowest detection limit of < 1 microM.

Ethanol biosensors and electrochemical oxidation of NADH.

Comparative studies of the electrochemical oxidation of reduced nicotinamide coenzyme (NADH) at the surfaces of chemically modified graphite paste electrodes (CMEs) are reported. Three different electroactive materials, tetracyanoquinodimethane (TCNQ), tetrathiafulvalene (TTF), and dimethyl ferrocene (dmFc), were used to construct three different chemically modified paste electrodes. The oxidation of NADH was examined on the basis of cyclic voltammetric measurements. The results show that all three mediators (TCNQ, TTF, and dmFc) behave as efficient mediators of the oxidation of NADH. The typical response curves of NADH at the CMEs surfaces are reported. Incorporating alcohol dehydrogenase and electroactive materials (TCNQ, TTF, and dmFc) within the graphite paste electrodes has led to the development of ethanol biosensors. Typical response curves for the ethanol analysis are reported. Comparative studies on the mediated electrochemical responses of the biosensors to ethanol are discussed.

Management of tamakashvsa (bronchial asthma) with pushkaramooladi choorna.

Pushkaramooladi choorna was tried clinically in Tamaka shvasa  (Bronchial asthma) for a period of 45 days in concecutive 3 followups. The clinical, labortary and pulmonary function tests carried out show significant antiasthmatic effect.

Peroxide biosensors and mediated electrochemical regeneration of redox enzymes.

This article describes the research investigations on the development of the amperometric biosensors based on mediated bioelectrochemistry. The mediated bioelectrochemistry involving horseradish peroxidase and glucose oxidase within the graphite paste is reported. The enzyme horseradish peroxidase together with electrochemical mediator was incorporated within the graphite paste electrode. The amperometric response is based on the mediated electrochemical regeneration of peroxidase within the paste. The mediated electrochemical regeneration of peroxidase and glucose oxidase was studied and compared using three different electron transfer mediators-tetracyanoquinodimethane (TCNQ), tetrathiafulvalene (TTF), and dimethyl ferrocene (dmFc). The mediated electrochemistry involving these three mediators was studied based on the cyclic voltammetry. The electrochemical measurements show that TTF is better mediator for the development of peroxide biosensor compared to TCNQ and dmFc. On the other hand, TCNQ is better mediator for the development of glucose sensor. The response curves for peroxide have been reported using these three mediators. A comparative study on the amperometric response based on the mediated electrochemical oxidation of peroxidase and glucose oxidase has also been made using these three mediators. The various parameters, i.e., background current, stability of the mediator within the graphite paste during the electrochemical measurements, and reproducibility of the amperometric response, are discussed.