Antibacterial activity directed isolation of compounds from Punica granatum.

Chemical investigation of the methanolic extract of pomegranate fruit following antibacterial activity directed isolation led to the isolation of pelargonidin-3-galactose, cyanidin-3-glucose, gallic acid, quercetin, and myricetin. All these compounds exhibited substantial activity against species of corynebacteria, staphylococci, streptococci, Bacillus subtilis, Shigella, Salmonella, Vibrio cholera, and Escherichia coli. However, all these compounds were more active against Gram-positive species. On comparing the activity of all the isolated pure compounds, it was found that gallic acid showed the highest antibacterial activity against all the tested sensitive strains and the activity of the remaining pure compounds was almost same due to the structural similarities of the compounds. The reason for antibacterial activity of all pure compounds was attributed to their phenolic structure.

Does use of isotretinoin rule out a career in flying?

AIM: To evaluate whether previous isotretinoin use induces permanent, measurable, and clinically significant abnormalities in night vision such that flying is precluded, and whether potential military and civilian commercial aviators should be screened routinely. METHODS: A retrospective, non-interventional, consecutive case series of 47 individuals with a confirmed history of oral isotretinoin use were compared to 20 age and sex matched controls. RESULTS: 47 individuals (44 males and three females), age range 17-33, underwent Goldmann-Weekers dark adaptation (DA) and standard electroretinogram (ERG) according to ISCEV protocols. 34 patients showed no abnormality in any parameters. Two patients had abnormal DA and ERGs. The mean scotopic ERG b wave amplitude of the isotretinoin group was 496.5 microV (SD 51.3 microV) compared with 501.7 microV (62.3.1 microV) among the controls. The group mean a:b ratio was 0.55 (0.04) compared to 0.69 (0.08) in the controls. CONCLUSION: Previous use of isotretinoin may have caused retinal toxicity in two subjects and laboratory evidence of night blindness in 11 further subjects. One subject had subclinical changes remaining in the ERG 96 months after cessation of isotretinoin. This may justify the directed use of electrophysiological screening in professions that are night vision critical.

Outcome and clinical implications of a surveillance and treatment program for Staphylococcus aureus nasal carriage in peritoneal dialysis patients.

Staphylococcus aureus nasal carriage (SANC) is a risk factor for development of S. aureus dialysis-related infections. Reported here are results of a SANC surveillance and treatment program employed by our dialysis unit over a two-year period. Surveillance nasal cultures were performed at 3-month intervals in 129 peritoneal dialysis patients. Those with SANC applied mupirocin ointment intranasally 3 times daily for 5 consecutive days for 3 consecutive months. Treatment was repeated only when subsequent cultures showed SANC. Infection and catheter loss rates were compared to 63 historical controls, and between SANC and non SANC patients of the study group. Patients who were initially non carriers showed increasing probability for acquiring SANC throughout the study period. Following treatment, the probability for recurrence of SANC was 26%, 41%, 58%, and 62% at 1, 3, 6, and 12 months. The rates of S. aureus exit-site or tunnel infection (p = 0.36), peritonitis (p = 0.0002), and catheter loss (p = 0.01) were lower in the study group as compared to controls. Despite treatment, SANC patients demonstrated a twofold increase in exit-site/tunnel infection rate (p = 0.03) and a threefold increase in catheter loss rate (p = 0.1) as compared to non SANC patients. The high rate of SANC recurrence and the long interval between surveillance cultures may explain the failure of the current protocol to completely eliminate the risk for S. aureus infections. The results support a change in the treatment plan to that of continuing the monthly mupirocin regimen indefinitely once SANC has been identified.

Dialysis catheter infection related peritonitis: incidence and time dependent risk.

The aim of this study was to conduct an in-depth analysis of the relationship of exit site and tunnel infection (ES/TI) to peritonitis and catheter loss in peritoneal dialysis patients, with emphasis on the incidence and risk of infection over time. Bacterial epidemiologies of 63 consecutively implanted catheters were studied for a combined total of 1,248 dialysis months. Analyses of bacterial profiles, infection rates, probabilities of time to first infection, and catheter survival were performed. The probability of first ES/TI and peritonitis was greatest during the first postimplant year. The earlier in dialysis history that patients developed an infection, the more infection prone they continued to be during the course of their dialysis experience. Staphylococcus aureus was the predominant organism for both ES/TI and peritonitis. The incidence of S. aureus infection was greatest during the first year and decreased over time on dialysis. S. aureus ES/TI caused significant risk for subsequent development of peritonitis, and 93% of ES/TI related peritonitis episodes were caused by this organism. Half of all ES/TIs that led to related peritonitis occurred by 3.5 months, and 100% by 12.8 months postimplant. S. aureus ES/TI related peritonitis led to catheter loss in 85% of cases. Our study identified a high risk period for infection for as long as 12 months postimplant. The inherent characteristics of ES/TI related peritonitis suggest that prevention should focus on both the organism and time period at risk. These findings are important in considering issues regarding S. aureus prophylaxis regimens versus nasal carrier treatment protocols.

The risk of infection and peritoneal catheter loss from implant procedure exit-site trauma.

OBJECTIVE: To evaluate the role of skin and subcutaneous tissue trauma at the time of catheter implant procedure as a determinant of catheter loss from infectious complications. DESIGN: Nonrandomized study with prospective collection of data. PATIENTS: Consecutive patients were divided into three groups based upon how the catheter was exited through the skin: group 1, procedure involved pulling tubing, with a permanently bonded catheter adapter, through the exit-site wound (n = 43); group 2, same as group 1 except exit wounds were closed around the catheter with a suture (n = 20); group 3, procedure involved pulling only tubing through the exit wound (n = 61). SETTING: Primary medical center for a health maintenance organization. MAIN OUTCOME MEASURES: Log rank comparisons of Kaplan-Meier analyses of first occurrences of infectious events and overall catheter survival. RESULTS: The risk of first exit-site infection (p < 0.001), tunnel infection (p < 0.001), catheter infection-related peritonitis (p < 0.001), and catheter loss (p < 0.01) were greatest in group 1 with large exit wounds, and lowest in group 3 with small exit wounds. CONCLUSIONS: The study demonstrates the importance of careful dissection and exit-site construction. The exit site should consist of the smallest hole possible that permits passage of only the tubing and leaves the skin snug around the catheter. The present report incriminates catheter designs employing permanently bonded adapters that result in large pericannular wounds that are prone to infection and catheter loss.

Long-term experience with polyurethane, pail handle, coiled tip peritoneal dialysis catheters.

Long-term experience with 63 polyurethane, pail handle, coiled tip peritoneal dialysis catheters surgically implanted in 57 consecutive patients with renal failure is presented. One hundred percent follow-up of the study group represented 1,248 patient-months of observation. Cumulative catheter survival rates were 80.8% at 12 months, 62.3% at 24 months, and 48.1% through 51 months. Catheter half-life was 32.6 months. Infection was the most frequent catheter related complication. Incidence rate of peritonitis was 0.73, and exit site/tunnel infection was 0.42 episodes per patient-year. Median time to first episode was 11.7 months for peritonitis, and 26.3 months for exit site/tunnel infection. Infection led to removal of 28.6% of implanted devices, mechanical blockage resulted in 6.4% loss, and pericatheter leak and tubing break each accounted for 1.6% of catheter removals. The polyurethane, pail handle, coiled tip peritoneal catheter was found to be a reliable long-term access device compared with reported performances of other catheter types. An adverse outcome was identified in the current clinical series with a model design using a permanently attached catheter adapter that caused large exit site wounds that were predisposed to infection and catheter loss.

Growth response of Listeria monocytogenes NCTC 7973 in two different media at four incubation temperatures.

Listeria monocytogenes NCTC 7973 was cultivated in tryptose phosphate broth (TPB) and tryptone soya broth (TSB) at four different temperatures: 4 degrees, 20 degrees, 30 degrees and 37 degrees C. Cells grown in TSB at 20 degrees C displayed maximum absorbance over cells grown in TPB at the same temperature. Moreover, this observation was further confirmed by dry mass determination and viable count. We determined that cells grown in TSB at 20 degrees C exhibited significant enhanced growth as compared to cells grown in TPB at the same temperature, hence TSB was found to be the medium of choice for maximum biomass production.

Amino acid requirement of six strains of Listeria monocytogenes.

Different serovars of Listeria monocytogenes grew well in a chemically defined medium. Sixteen amino acids were tested for the growth of L. monocytogenes. Most strains required cystine, valine, isoleucine, and leucine. Phenylalanine was a stimulatory growth factor for all six strains of Listeria. Whilst tryptophan was essentially required by NCTC 7973, LM and C-286 and stimulatory for 4155 and C-294, none of the strains did exhibit requirements of asparagine, glutamine, proline, histidine and tyrosine as essential/stimulatory growth factor.

Beta-blocker therapy in patients with ventricular tachyarrhythmias in the setting of left ventricular dysfunction.

Although several studies suggest beta blockers (BB) are effective in suppressing ventricular arrhythmias, less is known about their role in the treatment of patients with ventricular tachyarrhythmias associated with impaired left ventricular function. To assess the tolerance and efficacy of these agents, 32 patients presenting with either ventricular fibrillation (18) or sustained ventricular tachycardia (14) were studied during BB therapy. Left ventricular dysfunction (mean ejection fraction 29%) was present as a consequence of coronary artery disease (26) or cardiomyopathy (6). Baseline arrhythmia assessment revealed recurrent ventricular tachycardia in all patients. Antiarrhythmic drug therapy including BB was guided by programmed stimulation (10), exercise testing (8), ambulatory monitoring (12), or was given empirically (2). Beta blockers were well tolerated, as measured by exercise duration, which improved significantly, and by long-term maintenance, which continued in 23 of 32 (72%) patients. Over a mean follow-up of 668 days, patients treated with BB had a relatively low incidence of both sudden (3%) and nonsudden (9%) death. Thus, BB can be effective and well tolerated adjunct therapy in patients with a history of ventricular tachyarrhythmias in the setting of impaired left ventricular function.

Proarrhythmic effects of antiarrhythmic drugs during programmed ventricular stimulation in patients without ventricular tachycardia.

The proarrhythmic effects of class IA antiarrhythmic drugs were prospectively evaluated during programmed ventricular stimulation in 24 consecutive patients with frequent ventricular premature beats whose baseline study, performed while no antiarrhythmic drugs were being taken, showed no inducible sustained ventricular arrhythmias. No patient had nonsustained (greater than 5 beats) or sustained ventricular tachycardia by history or baseline 24 hour ambulatory electrocardiographic monitoring. Sequential stimulation studies using up to three extra-stimuli were performed after administration of procainamide, quinidine and disopyramide on different days. Proarrhythmic response was defined as induction of one or more of the following: sustained monomorphic ventricular tachycardia; sustained polymorphic ventricular tachycardia; ventricular fibrillation; reproducibly inducible nonsustained monomorphic ventricular tachycardia. During 55 antiarrhythmic drug trials (24 of procainamide, 21 of quinidine, 10 of disopyramide) in the 24 patients, 6 patients had a proarrhythmic response: sustained monomorphic ventricular tachycardia in 3, ventricular fibrillation in 2, nonsustained monomorphic ventricular tachycardia in 1. Thus, 11% of drug trials resulted in a proarrhythmic response and 25% of patients had a proarrhythmic response to one of the drugs tested. A proarrhythmic response to one drug did not predict a similar response to another drug of the same class. The 6 patients with a proarrhythmic response did not differ significantly from the other 18 patients with regard to underlying heart disease, electrocardiographic or baseline 24 hour ambulatory electrocardiographic characteristics; however, they did have a higher incidence of digoxin usage (p less than 0.02), a shorter baseline right ventricular effective refractory period (p less than 0.01) and a smaller increment in effective refractory period during antiarrhythmic drug testing (p = 0.06).(ABSTRACT TRUNCATED AT 250 WORDS)

Vitamin and nitrogen base requirements for Listeria monocytogenes and haemolysin production.

A complete chemically defined medium is described for the growth of different serovars of Listeria monocytogenes. The medium supported rapid, luxuriant and transferable growth. At the same time haemolysin production was induced to the same extent as in tryptose phosphate broth. Riboflavin and calcium-pantothenate were essential for the growth of all six strains tested. Biotin, pyridoxal-hydrochloride and p-aminobenzoic acid were either essential or stimulatory to all strains. Most strains did not require folic acid, thiamin, nicotinic acid and inositol, but they were stimulatory for some strains. Adenine was essential for two strains (NCTC 7973, 5214 m) while cytosine exhibited an inhibitory effect on the growth of all the strains.

A survey of blood groups.

A survey was conducted to investigate into the frequency of different blood groups in Punjab. A total of 1415 persons were included in this survey. The slide method was used for determination of ABO and AB blood groups as well as Rh factor. The frequency of blood group A was 21.20%; B, 36.16%; AB, 9.05% and O, 34.14%. Distribution of blood groups among various castes revealed the incidence of blood group A, 13.57% to 30%; B, 28.125% to 50%; O, 16.67% to 40%; and AB, zero to 25%. Only 2.76% cases were found to be Rh negative. Rh negative frequency was much higher in Baluchs, Awans and Gujjars than Rajputs, Jats and Arains.