Evaluation of bacteriophage cocktail on Urinary Tract Infection caused by colistin-resistant Klebsiella pneumoniae in mice model.

OBJECTIVE: The colistin-resistant Klebsiella pneumoniae causes complicated Urinary Tract Infections (UTIs). Of them, 73% of strains of K. pneumoniae formed moderate to strong biofilm. Multidrug-resistant (MDR)/Pandrug-resistant (PDR) bacteria causing UTIs are very challenging to conventional antibiotic therapy. However, bacteriophages may be a promising alternative as they easily disrupt the biofilm and act on receptors unrelated to antibiotic resistance mechanisms. This preclinical study evaluated the efficacy of a phage cocktail with different routes and dosages (in quantity and frequency) to eradicate the K. pneumoniae-associated UTI in the mice model. METHODS: The three lytic phages with the broadest spectrum activity (ΦKpnBHU1, ΦKpnBHU2, and ΦKpnBHU3) were meticulously characterized using SEM and sequencing. The cocktails were administered to mice through urethral, rectal, subcutaneous, and oral routes after establishing the UTI with 1 × 108 colony-forming unit/mouse (CFU/mouse) of K. pneumoniae (KpnBHU09) resistant to both the drugs carbapenem and colistin. The efficacy of different routes with varying dosages and frequency of administration was thoroughly optimized. RESULTS: We observed that two doses of a phage cocktail containing 1 × 105 Plaque-Forming Unit (PFU/mouse) and a single dose of 1 × 109 PFU/mouse per urethra could eradicate KpnBHU09. Intriguingly, the noninvasive administration through oral and rectal routes required higher concentration and many dosages of phages to eliminate KpnBHU09 at any stage of acute UTI. The subcutaneous route was found unsatisfactory in curing the infection. CONCLUSION: Bacteriophage cocktails administered through transurethral, oral, and rectal routes may cure UTIs.

Evaluation of Bacteriophage Cocktail on Septicemia Caused by Colistin-Resistant Klebsiella pneumoniae in Mice Model.

Objective: The emergence of resistance against last-resort antibiotics, carbapenem and colistin, in Klebsiella pneumoniae has been reported across the globe. Bacteriophage therapy seems to be one of the most promising alternatives. This study aimed to optimize the quantity and frequency of bacteriophage cocktail dosage/s required to eradicate the Klebsiella pneumoniae bacteria in immunocompetent septicemic mice. Methods: The three most active phages ɸKpBHU4, ɸKpBHU7, and ɸKpBHU14 characterized by molecular and TEM analyses were in the form of cocktail and was given intraperitoneally to mice after inducing the septicemia mice model with a constant dose of 8 × 107 colony-forming unit/mouse (CFU/mouse) Klebsiella pneumoniae. After that, the efficacy of the phage cocktail was analyzed at different dosages, that is, in increasing, variable, constant, and repeated dosages. Furthermore, interleukin-6 and endotoxin levels were estimated with variable doses of phage cocktail. Results: We have elucidated that phage therapy is effective against the Klebsiella pneumoniae septicemia mice model and is a promising alternative to antibiotic treatments. Our work delineates that a single dose of phage cocktail with 1 × 105 plaque-forming unit/mouse (PFU/mouse) protects the mice from fatal outcomes at any stage of septicemia. However, a higher phage dosage of 1 × 1012 PFU/mice is fatal when given at the early hours of septicemia, while this high dose is not fatal at the later stages of septicemia. Moreover, multiple repeated dosages are required to eradicate the bacteria from peripheral blood. In addition, the IL-6 levels in the 1 × 105 PFU/mouse group remain lower, but in the 1 × 1012 PFU/mouse group remains high at all points, which were associated with fatal outcomes. Conclusion: Our study showed that the optimized relatively lower and multiple dosages of phage cocktails with the strict monitoring of vitals in clinical settings might cure septicemia caused by MDR bacteria with different severity of infection.

Assessment of air pollution caused by illegal e-waste burning to evaluate the human health risk.

The onset of the 21st century has started a corresponding change in consumer lifestyles, resulting in the generation of a huge amount of the end-of-life electronics, known as e-waste. The e-waste recycling activities can pose a high risk to the environment and human health. We monitored air pollution levels (PM10) and heavy metal concentrations (Pb, Cu, Zn, Ni and Cr) in the air for three consecutive months in an area where illegal e-waste recycling was in operation and compared the results with other two residential sites. In addition, we measured the concentrations of the same heavy metals in human blood to find out if there exists any correlation between environmental and biological exposure. Hypoxemia and hypertension were also determined for the comparison of health status amongst the study population. The study design comprised of three sites, which were selected on the basis of different major activities in the respective areas. Air samples were collected with the help of RDS and subjected to heavy metals analysis by ICP-OES, whereas blood samples were analyzed by ICP-MS. Results showed that amongst all study sites significant highest mean concentration of PM10 (243.310 ±â€¯22.729 µg/m3) and its heavy metal was found at e-waste burning site (SIII). High levels of heavy metal in the air were responsible for the higher exposure to the residents of SIII. Therefore, the study concluded that e-waste burning by the informal sector has significantly contributed to the high levels of the air pollution, which in turn was responsible for the highest level of heavy metal exposure to the residents. This was also associated with the occurrence of cardiovascular morbidity namely hypertension amongst the inhabitants of SIII may indicate the effect of chronic exposure to the air pollution due to e-waste processing activities, which needs to be studied further.

Analyzing Social Networks to Examine the Changing Governance Structure of Springsheds: A Case Study of Sikkim in the Indian Himalayas.

The governance of natural resources now attracts greater participation of different stakeholders, ushering in a shift from conventional governance by the state to that by a network of stakeholders-a form of governance marked by a growing role of non-state and local actors. These changing dynamics are highlighted through a study of the governance network for springsheds in the Indian Himalayas by empirically mapping the changes in the Dhara Vikas Yojna, a plan or scheme (yojana) by the state for the development (vikas) of springs (dhara) in Sikkim, India, from policy planning to policy implementation. The study highlights the diverse existing and emerging roles of different stakeholders, the complex relationships between them, and the power dynamics that influence the management of springsheds. The study (1) identified some new but missing actors/actor groups that were critical to managing springs; (2) showed that although state governments continue to play a dominant role, decision making is shifting to non-state and local actors; and (3) highlighted the importance of exchanging knowledge and information in implementing a policy more effectively. Understanding the characteristics of the governance network helped in drawing lessons to make the plan more sustainable and replicable, which include considering the policy in the wider context of policies for other sectors such as sanitation and hydropower development, incentivising the emerging actors, and building a stronger interdisciplinary and inclusive knowledge network. Such an integrated approach to policymaking can also be adopted to analyze governance networks related to natural resources other than water.

Direct fetal intravenous immunoglobulin infusion as an adjunct to intrauterine fetal blood transfusion in rhesus-allommunized pregnancies: a pilot study.

OBJECTIVES: To study the usefulness of direct fetal intravenous immunoglobulin (IVIG) infusion along with intrauterine transfusion (IUT) in the management of severe fetal anemia in rhesus (Rh) alloimmunized pregnancies. METHODS: Thirty-four consecutive Rh-isoimmunized pregnant women who required serial IUTs received either blood alone (control group, n = 16) or IVIG and blood (study group, n = 18). Pregnancies were followed up to delivery, and fetal outcome was recorded. The rate of fall of hematocrit was measured and compared between the two groups. RESULTS: There was a slower rate of fall of hematocrit in the study group (IUT and IVIG) compared to the control group (only IUT). The mean rate of fall was 0.72 ± 0.54% per day in the study group while it was 1.29 ± 0.95% per day in the control group (p = 0.005). CONCLUSION: Fall of fetal hematocrit was reduced in the study group. The results of this pilot study can be used to time the next transfusion in patients receiving IVIG along with IUT (taking the rate of fall as 0.70%). This may eventually result in decreasing the number of transfusions per fetus.

Successful management of heterotopic pregnancy after fetal reduction using potassium chloride and methotrexate.

Heterotopic pregnancy, the presence of two gestational sacs simultaneously, is a rare event but with the advent of Assisted Reproductive Technology, it is now an increasingly common complication. The reported incidence of a heterotopic pregnancy in a spontaneous cycle is quoted as 1 in 30,000. We report the case of a 38-year-old primigravida who was referred to our center at 11 + 2 weeks gestation with a diagnosis of heterotopic pregnancy for further management. A non-surgical intervention comprising of transvaginal ultrasound-guided potassium chloride and methotrexate into the cervical pregnancy resulted in a successful outcome. As an obstetrician, a high index of clinical suspicion and an early scan is mandatory to make a diagnosis of a heterotopic pregnancy and manage accordingly.

Clinical correlates of pain and anxiety in prenatal diagnostic procedures.

OBJECTIVE: To study patient perception of pain and anxiety before and after amniocentesis (AC) and transabdominal chorionic villus sampling (CVS) and the clinical correlates of pain and anxiety. METHODS: 92 women underwent AC and 78 CVS. Visual analog scale was used to quantify pain and anxiety, immediately before and after the procedure. Factors which could affect pain and anxiety were noted. RESULTS: The pain and anxiety anticipated before the procedures were significantly less than actually perceived. The pre-procedure anxiety did not correlate with post-procedure pain. There was no correlation between anticipated pain or anxiety and age, parity, education, socioeconomic status, and history of procedure in previous pregnancy in both the AC and CVS groups. Post-procedure pain did not correlate with age, parity, education, socioeconomic status, abdominal scar, placental location, number of needle insertion, repeat procedure or abdominal wall thickness in either group. However, on multiple linear regression the overall post-procedure pain was associated with the number of needle insertions. CONCLUSION: Though pre-procedure pain and anxiety levels are high, most patient experience less pain and anxiety after the procedure.

Vascular hamartoma: an unusual cause of clitoromegaly in an 18-year-old patient.

OBJECTIVE: Clitoromegaly encountered in clinical practice is more commonly due to endocrinopathies either congenital or acquired. However, acquired clitoromegaly due to a nonhormonal cause is quite rare. The authors report a case of nonhormonal-acquired clitoromegaly in a woman. MATERIALS AND METHODS: This is a case report of an 18-year-old patient with slowly increasing swelling in the vulval area for the past 6 months. Clinical examination revealed an enlarged, soft, nontender clitoris (4 × 2.5 cm), with a lobulated surface. RESULTS: Frozen section from clitoral mass showed a benign tumor. Surgical excision of the mass was carried out, preserving the glans. Histopathologic examination of the excised mass showed congested blood vessels and fibromuscular tissue with free nerve endings suggestive of vascular hamartoma of clitoris. CONCLUSIONS: The correct diagnosis of clitoromegaly is essential so that suitable therapy is instituted. Thus, management of such cases needs a good clinical judgment and a judicious individualization of management protocols.

The art of fetoscopy: a step toward minimally invasive fetal therapy.

PURPOSE: To study the feasibility, learning curve, and safety of fetoscopy, so that fetal surgery can be confidently performed in ongoing pregnancies. METHODS: Fetoscopy was performed at 12-20 weeks of gestation, in 12 women with fetal congenital malformations and/or for termination of pregnancy, under local anesthesia using fine fetoscopes ranging from 1 to 2-mm diameter. The fetal parts and placenta were examined for clarity of vision, identification, and anomalies. RESULTS: Fetoscopy required great skill, patience, and extensive use of ultrasound for correct orientation. Visualization was better with endoscope of 2-mm diameter. Laser coagulation of placental vessels using diode laser system was possible in the last two cases. There were no major complications. CONCLUSIONS: Fetal endoscopy is a feasible procedure, safe in experienced hands but has an appreciable learning curve.

Pediatric foreign body aspiration: How much does our community know?

AIMS: Foreign body aspiration (FBA) is one of the main causes of accidental death in childhood. This study was designed to evaluate the level of awareness of FBA and its resultant dangers in the community. MATERIALS AND METHODS: Sixty-three primary caregivers were interviewed about their awareness of FBA, its attendant dangers, preventive measures taken, and how will they take care of a child in the event of a FBA according to an agreed protocol. RESULTS: Awareness levels about FBA were abysmally low in the population that was studied. Twenty-five percentage of the study population had not heard about this condition, and 46% could not recognize a FBA if it happened. Also, 76% of the study group did not know about the attendant dangers of this condition. CONCLUSIONS: There is a dire need to spread awareness about both prevention and treatment of this morbid condition. Health care professionals need to increase their efforts to spread more knowledge in the community about FBA.

Rupture of a malignant ovarian tumor in pregnancy presenting as acute abdomen.

INTRODUCTION: Ovarian neoplasms in pregnancy are usually asymptomatic rarely leading onto complications. A 30-year-old G2 P1+0+0+1 was referred at 30 weeks of pregnancy with an ultrasound diagnosis of a large multicystic ovarian cyst with no solid areas, ascites or evidence of metastasis. Antenatal corticosteroid was administered and she was advised to follow-up with reports of tumor markers. She presented a week later with acute pain abdomen and breathlessness. Clinical examination revealed a relaxed uterus and ultrasound was suggestive of rupture of the ovarian cyst. Exploratory laparotomy revealed a ruptured left mucinous ovarian cyst with no evidence of solid areas or metastasis. Left ovariotomy with infracolic omentectomy and concurrent cesarean section was done. A healthy male baby of weight 1.880 kg was delivered. Histopathology revealed stage-1c mucinous cyst adenocarcinoma of left ovary. This was followed-up, with a complete surgery done after a month. She is now receiving postoperative chemotherapy. CONCLUSION: This is the first reported case of a ruptured malignant ovarian tumor in pregnancy. Torsion or rupture of ovarian masses is an important differential diagnosis of abdominal or pelvic pain during pregnancy.