Bacteriophage therapy for Escherichia coli-induced urinary tract infection in rats.

Background: The present study evaluates the efficacy of bacteriophage therapy for urinary tract infection (UTI) in rats. Methods: UTI was established by inoculating Escherichia coli (100 µl) at a concentration of 1.5 × 108 CFU/ml per urethra via a cannula in different groups of rats. For treatment, phage cocktails (200 µl) were administered at varying concentrations of 1 × 108 PFU/ml, 1 × 107 PFU/ml and 1 × 106 PFU/ml. Results: The two doses of phage cocktail at the first two concentrations resulted in the cure of UTI. However, the lowest concentration of the phage cocktail warranted more doses to eradicate the causative bacteria. Conclusion: The quantity, frequency and safety of doses could be optimized in a rodent model using the urethral route.

Antimicrobial resistance is primarily caused by antibiotic overuse and misuse, which results in a decline in the ability of antibiotics to treat infections. Urinary tract infections (UTIs) are common but difficult to treat, as they are frequently caused by multidrug-resistant bacteria. Escherichia coli is a common cause of UTIs. Bacteriophages are a potentially viable alternative for the treatment of bacterial infections, and despite the numerous benefits of using phages as antibacterial therapeutics, there are surprisingly few original research articles based on clinical trials, specifically against UTIs. In this study, the efficiency of a customized bacteriophage cocktail for the treatment of UTIs, with varied doses administered directly into the urinary bladder of rats, was evaluated. At higher concentrations, UTIs were completely eradicated after two doses of the bacteriophage cocktail. However, at lower concentrations, additional doses were required to eradicate the infection. Phage therapy appears to have therapeutic potential, and this study indicates the potential frequency of dosages at appropriate concentrations. Phage therapy was both effective and safe.

Pseudoxanthomatous Mastocytosis in a 2-Month Female Infant.

Mastocytosis is a rare disease characterized by infiltration of mast cells in various tissues like skin, bone marrow, liver, spleen, and gastrointestinal tract. Here, we present a case report of diffuse cutaneous mastocytosis (pseudoxanthomatous type) in a neonate which is a rare presentation.

Time to speed up the diagnostic evaluation in clinically suspected rhinosinusitis patients: A debate on the conventional versus molecular workup to establish fungal infective etiology for prompt management.

Background and Purpose: Rhinosinusitis (RS) is a clinical and radiological diagnosis that rarely reaches a proper infective etiological diagnosis. The most dreaded fact about invasive fungal rhinosinusitis is its poor prognosis in immunocompromised patients with a 60-80% mortality rate. The present study highlights and compares the various diagnostic techniques to establish a fungal etiological diagnosis in clinically suspected cases of RS from nasal biopsy specimens, with the emphasis on the molecular diagnostic approach. Materials and Methods: This prospective study included a total of 34 clinically suspected cases of RS who had recently undergone functional endoscopic sinus surgery (FESS)/biopsy from nasal polyps. Various laboratory methods (microbiological and histopathological) were utilized, including direct microscopic examination of clinical samples and fungal culture isolation. The molecular detection method of polymerase chain reaction (PCR) from clinical samples was also explored simultaneously. Serum immunoglobulin-E (IgE) testing of patients was also performed. Results: Out of 34 clinically suspected RS cases, fungal etiology was established in a total of 18 cases, 17 of whom were culture-proven. A total of 15 and 14 culture-proven cases were also detected on direct microscopic examination by potassium hydroxide (KOH) mount and histopathological staining, respectively. One case was additionally identified by molecular method. Aspergillus flavus complex was the most common pathogen isolated in culture. Allergic fungal RS was the most common type, followed by acute and chronic invasive types among all fungal RS cases. Conclusion: Accurate and prompt etiological diagnosis of fungal RS is still lagging with fewer options for quick results. Although microscopy and culture isolation can't be replaced, PCR is a sensitive and specific method that should be incorporated as a supplementary tool for the early diagnosis and management, considering the delayed growth of fungi.

Laboratory diagnosis of mucormycosis: Present perspective.

Upsurge in mucormycosis cases in the second wave of SARS CoV2 infection in India has been reported. Uncontrolled diabetes is the major predisposing risk factor for these cases. The early diagnosis and surgical intervention with medical treatment may result in good clinical outcomes. The glycaemic control in diabetic patients also favours better treatment outcome in patients suffering from mucormycosis.

Immunological and safety profile of bacteriophage therapy: A pre-clinical study.

AIMS: Numerous pre-clinical and clinical studies have recently demonstrated the significant role of phage therapy in treating multidrug-resistant bacterial infections. However, only a few researchers have focused on monitoring the phage-mediated adverse reactions during phage therapy. The present study aimed to demonstrated the oral acute and sub-acute toxicity of bacteriophages (Klebsiella pneumoniae XDR strain) in Charles Foster rats with special reference to immunological response and adverse effects. METHODS AND RESULTS: Bacteriophages were orally administered in dosages of 1010  PFU/ml and a 1015  PFU/ml to Charles Foster rats as a single dose (in acute toxicity study) and daily dosage for 28 days (in sub-acute toxicity study). One millilitre suspension of bacteriophages was administered through the oral gavage feeding tube. No adverse effect was observed in any of the experimental as well as in the control animals. Furthermore, an insignificant change in food and water intake and body weight was observed throughout the study period compared with the control group rats. On the 28th day of phage administration, blood was collected to estimate haematological, biochemical and cytokines parameters. The data suggested no difference in the haematological, biochemical and cytokine profiles compared to the control group. No significant change in any of the treatment groups could be observed on the gross and histopathological examinations. The cytokines estimated, interleukin-1 beta (IL-1ß), IL-4, IL-6 and IFN-gamma, were found within the normal range during the experiment. CONCLUSIONS: The results concluded that no adverse effect, including the severe detrimental impact on oral administration of high (1010 PFU/ml) and very high dose (1015  PFU/ml) of the bacteriophages cocktail. SIGNIFICANCE AND IMPACT OF STUDY: The high and long-term oral administration of bacteriophages did not induce noticeable immunological response as well.

Pregabalin Induced Maculopapular Eruption in an Elderly Male.

BACKGROUND: Pregabalin is used in the treatment of neuropathic pain of various etiologies and as an adjuvant in epilepsy. Blockade of the α2δ subunit of L and N-type Ca-channels is its main mechanism of neurotropic action. Compared to other antiepileptics like phenytoin, valproate and lamotrigine, and other neuropathic pain medications such as amitriptyline and duloxetine, pregabalin has a relatively favorable safety profile and hence is a drug of choice for many geriatricians. CASE PRESENTATION: Here we describe a case of maculopapular rash induced by pregabalin in an older man, which resolved with withdrawal of the offending drug and conservative management. CONCLUSION: We have also conducted a literature review of similar cases and highlighted the clinical patterns and management strategies for pregabalin-induced skin rashes.

Study on the Effect of Oral Administration of Bacteriophages in Charles Foster Rats With Special Reference to Immunological and Adverse Effects.

Numerous pre-clinical and clinical studies have recently demonstrated the significant role of phage therapy in treating multidrug-resistant bacterial infections. However, only a few researchers have focused on monitoring the phage-mediated adverse reactions during phage therapy. Besides adverse reactions, immunological response after short- and long-term oral administration of bacteriophages is also lacking. In this study, we administered the bacteriophages orally against Klebsiella pneumoniae XDR strain in dosages of 1015 PFU/ml and a 1020 PFU/ml (still higher) to Charles Foster rats as a single dose (in acute toxicity study) and daily dosage for 28 days (in sub-acute toxicity study). One milliliter suspension of bacteriophages was administered through the oral gavage feeding tube. No adverse effect was observed in any of the experimental as well as in the control animals.Further, an insignificant change in food and water intake and body weight was observed throughout the study period compared with the control group rats. On the 28th day of phage administration, blood was collected to estimate hematological, biochemical, and cytokines parameters. The data suggested no difference in the hematological, biochemical, and cytokine profile compared to the control group. No significant change in any of the treatment groups could be observed on the gross and histopathological examinations. The cytokines estimated, interleukin-1 beta (IL-1ß), IL-4, IL-6, and INF-gamma, were found within the normal range during the experiment. The results suggested no adverse effect, including the severe detrimental impact on oral administration of high (1015 PFU/ml) and very high dose (1020 PFU/ml) of the bacteriophages cocktail. The high and long-term oral administration of bacteriophages did not induce noticeable immunological response as well.

Giant congenital melanocytic nevus associated with lipoma in an Indian man.

Congenital melanocytic nevus is a inborn melanocytic proliferation either present since birth or soon afterward and shows characteristic histopathological features comprising proliferation of benign melanocytes and extension of nevus cells into the deep reticular dermis and subcutis. We report the case of a 35-year-old male patient who presented with a progressively enlarging soft tissue mass in bilateral flank region. High-resolution ultrasound imaging showed multiple lipomatous masses within the soft tissues on the either flank region. Subsequent excision of the soft tissue mass showed a well-circumscribed lipomatous lesion with diffuse infiltration by benign appearing melanocytes within the fat lobules established by immunohistochemistry, which was positive for HMB45 and S100. This case serves to illustrate the initial diagnostic challenge in a male patient as well as the plasticity of the neural crest cells.

Haemostatic Profile of Patients with Chronic Liver Disease- its Correlation with Severity and Outcome.

INTRODUCTION: The liver plays an important role in the haemostatic system as it synthesizes the majority of coagulation factors and fibrinolytic proteins. AIM: The present study was planned to determine the range of haemostatic defects in patients of chronic liver diseases. MATERIALS AND METHODS: Test performed included Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT), Thrombin Time (TT), Fibrinogen, Protein C, D Dimer and platelet count. Comparisons between groups frequencies and groups means were made using Chi-square test and Student's t-test, respectively. RESULTS: In cirrhosis group PT, aPTT, TT and D Dimer level were significantly increased compared to Chronic Hepatitis (CH) and control group (p<0.001 for all comparisons). Serum fibrinogen, Protein C and platelet count were significantly reduced in cirrhosis patients compared to CH and control group. (p<0.001 for all comparisons). All studied coagulation parameters were within normal limit in CH group. However, statistically significant difference was found in protein C and mean platelet count in CH group compared to control (p=0.03 and p<0.001 respectively). No evidence of bleeding or thrombosis was present in study group. CONCLUSION: In cirrhosis patients severe derangement in both anti and procoagulant factors occurs. Haemostatic profile in chronic hepatitis patient remains within normal limits.

Lymphnodal Co-infection of Cryptococcus and Histoplasma in a HIV-Infected Patient and Review of Published Reports.

Human infection with Histoplasma capsulatum and Cryptococcus runs the gamut from asymptomatic illness to disseminated disease. Though both are the most prevalent systemic mycoses in HIV-infected patients, simultaneous infection by both the pathogens rarely occurs. We document the first case from Asian subcontinent with concurrent infection with disseminated cryptococcosis and histoplasmosis infections in a HIV-infected Indian patient diagnosed by morphological examination of fine-needle aspiration cytology samples obtained from the enlarged lymph nodes on light microscopy and were later confirmed by culture studies. A prompt, accurate and timely diagnosis of the disseminated form of dual mycosis (or either of the mycosis as well) is of utmost importance which has obvious impact on early initiation of treatment. Fine-needle aspiration cytology is a rapid, cost-effective and reliable method to identify infection with Cryptococcus and Histoplasma and is comparable with the essential culture studies.

Malignant lymphoma of stomach associated with duodenal carcinoid.

We report a 73-year-old man with diffuse large B-cell lymphoma of the stomach in whom distal gastrectomy specimen revealed coexisting carcinoid tumor of the duodenum. Postoperatively the patient received six cycles of chemotherapy (CHOP regimen) and was asymptomatic nine months later.