Prevalence and antimicrobial resistance of food safety related Vibrio species in inland saline water shrimp culture farms / Prevalencia y resistencia a los antimicrobianos de especies de Vibrio relacionadas con la inocuidad de los alimentos en granjas de cultivo de camarones de aguas saladas continentales

This study evaluated the potential pathogenicity and antimicrobial resistance (AMR) of Vibrio species isolated from inland saline shrimp culture farms. Out of 200 Vibrio isolates obtained from 166 shrimp/water samples, 105 isolates were identified as V. parahaemolyticus and 31 isolates were identified as V. alginolyticus and V. cholerae, respectively. During PCR screening of virulence-associated genes, the presence of the tlh gene was confirmed in 70 and 19 isolates of V. parahaemolyticus and V. alginolyticus, respectively. Besides, 10 isolates of V. parahaemolyticus were also found positive for trh gene. During antibiotic susceptibility testing (AST), very high resistance to cefotaxime (93.0%), amoxiclav (90.3%), ampicillin (88.2%), and ceftazidime (73.7%) was observed in all Vibrio species. Multiple antibiotic resistance (MAR) index values of Vibrio isolates ranged from 0.00 to 0.75, with 90.1% of isolates showing resistance to ≥ 3 antibiotics. The AST and MAR patterns did not significantly vary sample-wise or Vibrio species-wise. During the minimum inhibitory concentration (MIC) testing of various antibiotics against Vibrio isolates, the highest MIC values were recorded for amoxiclav followed by kanamycin. These results indicated that multi-drug resistant Vibrio species could act as the reservoirs of antibiotic resistance genes in the shrimp culture environment. The limited host range of 12 previously isolated V. parahaemolyticus phages against V. parahaemolyticus isolates from this study indicated that multiple strains of V. parahaemolyticus were prevalent in inland saline shrimp culture farms. The findings of the current study emphasize that routine monitoring of emerging aquaculture areas is critical for AMR pathogen risk assessment.(AU)

Envisioning environmental equity: climate change, health, and racial justice.

Climate change has a broad range of health impacts and tackling climate change could be the greatest opportunity for improving global health this century. Yet conversations on climate change and health are often incomplete, giving little attention to structural discrimination and the need for racial justice. Racism kills, and climate change kills. Together, racism and climate change interact and have disproportionate effects on the lives of minoritised people both within countries and between the Global North and the Global South. This paper has three main aims. First, to survey the literature on the unequal health impacts of climate change due to racism, xenophobia, and discrimination through a scoping review. We found that racially minoritised groups, migrants, and Indigenous communities face a disproportionate burden of illness and mortality due to climate change in different contexts. Second, this paper aims to highlight inequalities in responsibility for climate change and the effects thereof. A geographical visualisation of responsibility for climate change and projected mortality and disease risk attributable to climate change per 100 000 people in 2050 was conducted. These maps visualise the disproportionate burden of illness and mortality due to climate change faced by the Global South. Our third aim is to highlight the pathways through which climate change, discrimination, and health interact in most affected areas. Case studies, testimony, and policy analysis drawn from multidisciplinary perspectives are presented throughout the paper to elucidate these pathways. The health community must urgently examine and repair the structural discrimination that drives the unequal impacts of climate change to achieve rapid and equitable action.

Prevalence and antimicrobial resistance of food safety related Vibrio species in inland saline water shrimp culture farms.

This study evaluated the potential pathogenicity and antimicrobial resistance (AMR) of Vibrio species isolated from inland saline shrimp culture farms. Out of 200 Vibrio isolates obtained from 166 shrimp/water samples, 105 isolates were identified as V. parahaemolyticus and 31 isolates were identified as V. alginolyticus and V. cholerae, respectively. During PCR screening of virulence-associated genes, the presence of the tlh gene was confirmed in 70 and 19 isolates of V. parahaemolyticus and V. alginolyticus, respectively. Besides, 10 isolates of V. parahaemolyticus were also found positive for trh gene. During antibiotic susceptibility testing (AST), very high resistance to cefotaxime (93.0%), amoxiclav (90.3%), ampicillin (88.2%), and ceftazidime (73.7%) was observed in all Vibrio species. Multiple antibiotic resistance (MAR) index values of Vibrio isolates ranged from 0.00 to 0.75, with 90.1% of isolates showing resistance to ≥ 3 antibiotics. The AST and MAR patterns did not significantly vary sample-wise or Vibrio species-wise. During the minimum inhibitory concentration (MIC) testing of various antibiotics against Vibrio isolates, the highest MIC values were recorded for amoxiclav followed by kanamycin. These results indicated that multi-drug resistant Vibrio species could act as the reservoirs of antibiotic resistance genes in the shrimp culture environment. The limited host range of 12 previously isolated V. parahaemolyticus phages against V. parahaemolyticus isolates from this study indicated that multiple strains of V. parahaemolyticus were prevalent in inland saline shrimp culture farms. The findings of the current study emphasize that routine monitoring of emerging aquaculture areas is critical for AMR pathogen risk assessment.

Complete genome sequencing and characterization of single-stranded DNA Vibrio parahaemolyticus phage from inland saline aquaculture environment.

Despite their evolutionary, molecular biology and biotechnological significance, relatively fewer numbers of single-stranded DNA (ssDNA) filamentous phages belonging to the family Inoviridae have been discovered and characterized to date. The present study focused on genome sequencing and characterization of an ssDNA Vibrio parahaemolyticus phage V5 previously isolated from an inland saline shrimp culture farm. The complete circular genome of phage V5 consisted of 6658 bp with GC content of 43.7%. During BLASTn analysis, only 36% of phage V5 genome matched with other Vibrio phage genomes in the NCBI database with a sequence identity value of 79%. During the phylogenetic analysis, phage V5 formed a separate branch in the minor clade. These features indicate the novel nature of the phage V5 genome. Among 10 predicted open reading frames (ORFs) in the phage V5 genome, 6 encoded for the proteins of known biological functions, whereas the rest were classified as hypotheticals. Proteins involved in replication and structural assembly were encoded by the phage genome. However, the absence of genes encoding for DNA/RNA polymerases and tRNAs signified that phage V5 is dependent on the host`s molecular machinery for its propagation. As per our knowledge, this is the first study describing the novel genome sequence of an ssDNA V. parahaemolyticus phage from the inland saline environment.

A randomized comparative study of methylcobalamin, methylcobalamin plus pregabalin and methylcobalamin plus duloxetine in patients of painful diabetic neuropathy.

CONTEXT: Diabetic neuropathy affects 10.5%-32.2% of diabetic population posing clinical burden onto society. AIMS: We aimed to study the efficacy, safety, and tolerability of methylcobalamin, methylcobalamin plus pregabalin, and methylcobalamin plus duloxetine in patients of painful diabetic neuropathy. SETTINGS AND DESIGN: It is a prospective, randomized, open-label, interventional, and parallel-group study done in patients of painful diabetic neuropathy. MATERIALS AND METHODS: A total of 100 patients were recruited and randomized to three study groups A, B, and C on methylcobalamin, methylcobalamin and pregabalin, and methylcobalamin and duloxetine, respectively. Patients were assessed at day 0 and 4, 8, and 12 weeks. The tuning fork test, monofilament test, Thermal Sensitivity testing, and Visual Analog Scale (VAS) were used to analyze vibration, pressure, thermal sensitivity, and pain. STATISTICAL ANALYSIS USED: The results are expressed as mean ± standard deviation. Appropriate statistical methods were used to calculate P value (<0.05 - significant). RESULTS: The increase in number of patients with vibration perception is 11.6%, 37.9%, and 41.4%; pressure sensation is 7.6%, 37.9%, and 37.9%; and thermal sensitivity is 15.4%, 31.1%, and 37.9% in Groups A, B, and C, respectively. The decrease in VAS scores is 0.58 ± 0.14, 3.82 ± 0.05, and 4.17 ± 0.48 in Groups A, B, and C correspondingly. The adverse effects reported in Groups A, B, and C are 0%, 6.9%, and 10.3%, respectively. CONCLUSIONS: Group C is more efficacious when compared to Groups A and B while Group B is safer.

Physicochemical and microbiological evaluation of antioxidant-rich traditional black carrot beverage: Kanji.

BACKGROUND: Daucus carota subsp. sativus (Black carrots) are underutilized in context to their nutritional properties. In this study, Kanji, a naturally fermented probiotic beverage, was prepared using Daucus carota subsp. sativus (var. Punjab Black Beauty). Analysis of the physicochemical and microbiological profile of the naturally fermented Kanji was investigated to boost its utilization for commercial purpose. RESULTS: The physicochemical parameters observed in the fermented Kanji beverage were pH 3.47, total soluble solids 3°B, lactic acid 0.99%, total sugars 36.32 mg/mL, total reducing sugars 27.16 mg/mL, flavonoids 38.14 mg/mL, phenols 40.8 mg/mL, antioxidant activity 79.96% and ascorbic acid 110 mg/100 mL. The microbiological analysis revealed an exponential increase in lactic acid bacterial count from 3.96 to 8.33 log CFU/mL. Out of 11 bacterial strains isolated from Kanji, the bacterial strain with high growth potential was genotypically characterized as Pediococcus acidilactici with accession number MK028218. CONCLUSION: The lactic acid bacterial Kanji beverage was characterized as a potential plant-based probiotic with high antioxidant activity. This functional autochthonous starter from the Kanji can be used for selective fermentation of black carrots for Kanji ascertaining its microbiological safety, unique flavor and aroma, and consumption as a commercial non-dairy-based probiotic beverage.

Multidisciplinary approach to L3/L4 lumbar disc prolapse masquerading as focal limb myositis-a radiological challenge.

Prolapsed intervertebral discs are commonly associated with back ache and sciatica. Management is often conservative with analgesia and physiotherapy. Nerve root injections and discectomy procedures are used where conservative measures fail. Majority of patients present with symptoms of pain and motor weakness; however, a few can present as focal myositis of lower limb muscles in the distribution of radiculopathy. MRI scans of limbs are rarely done in these cases but if done can confound the radiologist. Our case report emphasize the importance of multidisciplinary approach for a L3 nerve radiculopathy with confounding clinical presentation of focal lower limb myositis of unknown etiology.

Cilium incarnatum externum.

A 25-year-old woman presented with a history of a cosmetically bothersome bulge over her left eyelid. She was diagnosed with cilium incarnatum externum. The subcutaneous cilium was surgically removed and examined.

Chronic Obstructive Pulmonary Disease and the Risk of Stroke.

RATIONALE: Chronic obstructive pulmonary disease (COPD) has been identified as a risk factor for cardiovascular diseases such as myocardial infarction. The role of COPD in cerebrovascular disease is, however, less certain. Although earlier studies have suggested that the risk for stroke is also increased in COPD, more recent investigations have generated mixed results. OBJECTIVES: The primary objective of our review was to quantify the magnitude of the association between COPD and stroke. We also sought to clarify the nature of the relationship between COPD and stroke by investigating whether the risk of stroke in COPD varies with age, sex, smoking history, and/or type of stroke and whether stroke risk is modified in particular COPD phenotypes. RESULTS: The MEDLINE and EMBASE databases were searched in May 2016 to identify articles that compared stroke outcomes in people with and without COPD. Studies were grouped by study design to distinguish those that reported prevalence of stroke (cross-sectional studies) from those that estimated incidence (cohort or case-control studies). In addition, studies were stratified according to study population characteristics, the nature of COPD case definitions, and adjustment for confounding (smoking). Heterogeneity was assessed using the I2 statistic. We identified 5,493 studies, of which 30 met our predefined inclusion criteria. Of the 25 studies that reported prevalence ratios, 11 also estimated prevalence odds ratios. The level of heterogeneity among the included cross-sectional studies did not permit the calculation of pooled ratios, save for a group of four studies that estimated prevalence odds ratios adjusted for smoking (prevalence odds ratio, 1.51; 95% confidence interval, 1.09-2.09; I2 = 45%). All 11 studies that estimated relative risk for nonfatal incident stroke reported increased risk in COPD. Adjustment for smoking invariably reduced the magnitude of the associations. CONCLUSIONS: Although both prevalence and incidence of stroke are increased in people with COPD, the weight of evidence does not support the hypothesis that COPD is an independent risk factor for stroke. The possibility remains that COPD is causal in certain subsets of patients with COPD and for certain stroke subtypes.

An analysis of trends of incidence and cytohistological correlation of papillary carcinoma of the thyroid gland with evaluation of discordant cases.

BACKGROUND: The role of fine-needle aspiration cytology (FNAC) in thyroid nodules has been well-studied but there is a paucity of studies solely involving papillary thyroid carcinoma (PTC). The diagnostic criteria for PTC are established but still there is a worrisome possibility of false positive and false-negative results, which can have a serious impact on patient care. This article correlates the cytological and histological diagnosis of PTC with an eventual aim of analyzing the cause of false positive and false negative results in order to prevent misdiagnosis. An increase in the incidence of PTC in the younger population has been noted. AIMS: To analyze the epidemiological trends and cytohistological correlation of PTC and evaluate the discordant cases and pitfalls of FNAC. MATERIALS AND METHODS: Seventy-two cases who had undergone both FNAC and histopathological examination (HPE) of the thyroid gland were selected. Age and sex distribution as well as cytohistological correlation were done for all the cases. RESULTS: Cytohistological correlation was 81.94%. False positives were 5.56% and the false negative rate was 13.2%. Sensitivity was 86.7% and the positive predictive value was 93.6%. The peak age was 31-40 years among females and 41-60 years among males. Seven of our patients were <20 years of age (10%). CONCLUSION: FNAC is an indispensible tool for the early diagnosis of PTC. However, certain conditions of the thyroid gland can cause diagnostic dilemma. Awareness of pathologists regarding these pitfalls can prevent misdiagnosis and provide better patient care. Increasing the incidence of PTC with a more striking increase in the younger population makes early diagnosis all the more important owing to better prognosis in this age group.

Chronic obstructive pulmonary disease and the risk of stroke: a systematic review protocol.

INTRODUCTION: There is good evidence to suggest that chronic obstructive pulmonary disease (COPD) increases the risk of ischaemic heart disease, in particular myocardial infarction (MI). The relationship between stroke and COPD, however, is not as well established, and studies conducted to date have generated conflicting results. METHODS AND ANALYSIS: MEDLINE and Embase will be searched for relevant articles using a prespecified search strategy. We will target observational studies conducted in the general population that employ either a longitudinal cohort or case-control study design to estimate ORs, HRs or incident rate ratios for the association between COPD and a subsequent first stroke. Both stages of screening, title and abstract followed by full-text screening, will be conducted independently by two reviewers. The Population, Exposure, Comparator, Outcomes, Study characteristics (PECOS) framework will be used to systematise the process of extracting data from those studies meeting our selection criteria. Study quality will be assessed using an adapted version of the Newcastle-Ottawa risk of bias tool. The data extraction and the risk of bias assessment will also be conducted in duplicate. A meta-analysis will be considered if there is sufficient homogeneity across selected studies or groups of studies. If a meta-analysis is not justified, a narrative synthesis will be conducted. Selected Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria will be used to assess the quality of the cumulative evidence. DISSEMINATION: Currently ranking second and fourth in the list of global causes of mortality, respectively, stroke and COPD are important non-communicable diseases. With this review, we hope to clarify some of the current uncertainty that surrounds the COPD-stroke relationship and in turn improve understanding of the nature of the role of COPD in comorbid stroke. PROSPERO REGISTRATION NUMBER: CRD42016035932.

Diagnostic accuracy of fine needle aspiration cytology of thyroid and evaluation of discordant cases.

INTRODUCTION: The main role of fine needle aspiration cytology (FNAC) lies in differentiating between a malignant and benign thyroid nodule. It greatly influences the treatment decision. The current study was undertaken to evaluate the cytology-histopathology correlation and to analyze the cause of diagnostic errors with an eventual aim to improve diagnostic accuracy. MATERIALS AND METHODS: This is a retrospective study comparing cytology and corresponding histopathology report in 724 thyroid cases. The statistical analysis included false positive rate, false negative rate, sensitivity, specificity, positive predictive value, negative predictive value and accuracy. RESULTS: On cytological examination, 635/724 were reported as benign, 68 malignant and 21 suspicious. On histopathological examination, 626/635 cases were confirmed as benign but there were 9 discordant cases. Among the other cases histopathology diagnosis of malignancy matched in 66/68 and 11/21 cases. Diagnosis correlated in 703/724 cases (97%) [p<0.001]. False positive and false negative rates were 1.9% and 10.5%, respectively. The sensitivity and specificity were 89.5% and 98%, respectively. The positive predictive value was 84.6% and negative predictive value was 98.6%. Accuracy of FNA was 97%. CONCLUSION: In spite of high accuracy of FNAC in differentiating between a benign and malignant lesion, certain pitfalls should be kept in mind. The common false negative diagnoses were follicular pattern cases which constitute a 'gray zone', cystic papillary thyroid carcinoma (PTC) and papillary microcarcinoma. The reason for false positive diagnoses was the occurrence of nuclear features characteristic of PTC in other thyroid lesions. Awareness of pathologist regarding these pitfalls can minimize false negative/positive diagnoses.

Current Protocols of Corneal Collagen Cross-Linking: Visual, Refractive, and Tomographic Outcomes.

PURPOSE: To study the effect of different protocols of collagen cross-linking on visual, refractive, and tomographic parameters in patients with progressive keratoconus. DESIGN: Prospective randomized interventional study. METHODS: In this study, 138 eyes of 138 patients with progressive keratoconus underwent corneal collagen cross-linking (CXL). Following detailed preoperative examination, Group I underwent conventional cross-linking (36 patients, 3 mW/cm(2) for 30 min); Group II (36 patients, 9 mW/cm(2) for 10 min), Group III (33 patients, 18 mW/cm(2) for 5 min), and Group IV (33 patients, 30 mW/cm(2) for 3 min) underwent accelerated cross-linking. Changes in corrected distance visual acuity (CDVA), spherical equivalent (SE), flat keratometry, steep keratometry, thinnest pachymetry, specular microscopy, and demarcation line were studied at 6 and 12 months. RESULTS: Improvement in the mean CDVA and SE were statistically significant in all groups except Group IV (P = .15 at 6 months, P = .17 at 12 months), with Group III (P = .01 at 6 and 12 months) showing the best results. Flattening of steep and flat keratometry was significant in Groups I (P = .01) and II (P = .01) as compared to the other groups. There was no significant difference in the pachymetry or specular microscopy in any of the groups. Groups I and II demonstrated a good demarcation line when compared to other groups. CONCLUSION: Conventional CXL (Group I) and accelerated CXL with irradiations of 9 mW/cm(2) (Group II) and 18 mW/cm(2) (Group III) showed better visual, refractive, and tomographic improvements at the end of 12 months.

Disruption of the PI3K/AKT/mTOR signaling cascade and induction of apoptosis in HL-60 cells by an essential oil from Monarda citriodora.

We have isolated an essential oil from Monarda citriodora (MC) and characterized its 22 chemical constituents with thymol (82%), carvacrol (4.82%), ß-myrcene (3.45%), terpinen-4-ol (2.78%) and p-cymene (1.53%) representing the major constituents. We have reported for the first time the chemotherapeutic potential of MC in human promyelocytic leukemia HL-60 cells by means of apoptosis and disruption of the PI3K/AKT/mTOR signaling cascade. MC and its major constituent, thymol, inhibit the cell proliferation in different types of cancer cell lines like HL-60, MCF-7, PC-3, A-549 and MDAMB-231. MC was found to be more cytotoxic than thymol in HL-60 cells with an IC50 value of 22 µg/ml versus 45 µg/ml for thymol. Both MC and thymol induce apoptosis in HL-60 cells, which is evident by Hoechst staining, cell cycle analysis and immuno-expression of Bcl-xL, caspase-3,-8,-9 and PARP-1 cleavage. Both induce apoptosis by extrinsic and intrinsic apoptotic pathways that were confirmed by enhanced expression of death receptors (TNF-R1, Fas), caspase-9, loss of mitochondrial membrane potential and regression of Bcl-2/Bax ratio. Interestingly, both MC and thymol inhibit the downstream and upstream signaling of PI3K/AKT/mTOR pathway. The degree of apoptosis induction and disruption of the PI3K signaling cascade by MC was significantly higher when compared to thymol.

Synovitis of the wrist joint caused by an intraarticular perforation of an osteoid osteoma of the scaphoid.

Uncommon location and atypical presentation of the osteoid osteomas of the scaphoid can pose a diagnostic challenge. Because of its intraarticular location, scaphoid osteoid osteoma can present with synovitis which is the more commonly reported presentation for other intraarticular locations like in hip and elbow and only rarely reported at the wrist. We report a case of perforation of the osteoid osteoma into the wrist joint, resulting in exuberant synovitis. The clinical significance of this report is to reinforce that synovitis can be a presentation of osteoid osteoma and it should be considered in the differential diagnosis of monoarticular arthritis. Prolonged synovitis may cause damage to the other joint surfaces of the wrist and hence carpal osteoid osteoma should be considered for early surgical excision.

Concomitant avascular necrosis of the scaphoid and lunate.

Simultaneous avascular necrosis of multiple carpal bones is rare. Concomitant avascular necrosis of scaphoid and lunate has been reported only once. We report one more case of this rare condition which can be a cause of wrist pain. Steroid intake is a known risk factor for avascular necrosis but in our case the patient had been taking herbal medicines for joint pain the composition of which was not known. Probably the presence of steroid in these medicines was the cause of avascular necrosis in this case.

Histologic analysis and comparison of techniques in fine needle aspiration-induced alterations in thyroid.

OBJECTIVE: To assess histologic alterations following fine needle aspiration (FNA) of the thyroid and differentiate these from ominous lesions, such as papillary carcinoma thyroid, as well as assess and compare the degree of tissue trauma from the techniques: needle only vs. needle with syringe, size of needle and number of aspirations. STUDY DESIGN: Thyroidectomy specimens of 100 cases with prior FNA biopsy were selected. The changes called "worrisome histologic alteration following fine needle aspiration of the thyroid" (WHAFFT) were studied. Number of FNAs, needle size and technique were tabulated for 73 of 100 cases. RESULTS: Worrisome changes were confined to areas near the needle tract and hence could be differentiated from ominous lesions. Control cases did not show WHAFFT lesions. Non-aspiration FNA cytology (FNAC) technique results in fewer, less frequent WHAFFT changes. The increasing number of FNAs leads to statistically significant increase in infarction, necrosis and vascular changes. A gradation in the WHAFFT changes, directly proportional to the increasing diameter of the needle, was observed. CONCLUSION: The pathologist should be aware of WHAFFT to avoid misinterpretation. The technique of non-aspiration FNAC is significantly less traumatic. An increase in FNAs or size of needle results in more severe WHAFFT changes.