Anti-staphylococcal activity of a cyclic lipopeptide, C15 -bacillomycin D, produced by Bacillus velezensis NST6.

AIM: The aim of this study was to assess antibacterial activity of a novel Bacillus velezensis strain NST6, and further identify its active compound against pathogenic Staphylococcus strains for clinical therapeutic applications. METHODS AND RESULTS: In this study, a novel B. velezensis strain NST6 harbouring strong antimicrobial activity against human pathogenic bacteria was isolated from a soil sample. The solvent extract of the strain exhibited strong antibacterial activity against Gram-positive and Gram-negative bacteria in disc diffusion assay and measurement of minimal inhibitory concentration and bactericidal concentration, of which it showed notable efficacy to Staphylococcus species including Staphylococcus epidermidis, Staphylococcus aureus and methicillin-resistant S. aureus. Strong antibacterial effect against pathogenic S. aureus and low toxicity of the bacterial extract were further validated in Caenorhabditis elegans model. Moreover, by antibacterial activity-guided fractionation using RP-HPLC and LC-MS, we defined C15 -bacillomycin D as the anti-staphylococcal compound produced by the strain. CONCLUSION: The primary anti-staphylococcal compound from B. velezensis NST6 was identified as a cyclic lipopeptide, C15 -bacillomycin D, which proved its potential to treat Staphylococcus strains in vitro and in vivo experiments with insignificant level of toxicity. SIGNIFICANCE AND IMPACT OF THE STUDY: We provide an alternative treatment option to Staphylococcus infections by investigating the specific anti-staphylococcal activity of C15 -bacillomycin D produced by a B. velezensis strain.

Molecular typing of dengue viruses circulating in Assam, India during 2016-2017.

BACKGROUND & OBJECTIVES: The global incidence of dengue has grown dramatically in recent decades and Assam, India has witnessed several outbreaks of dengue since 2015. Although during post-monsoon months (September to December), most cases of dengue in Assam are recorded but incidence of dengue in Assam has been slowly changing from being endemic to being hyper endemic. Therefore, this study was carried out to determine the serotypes and genotypes of dengue virus prevalent in Assam during the period of 2016-2017. METHODS: This is a prospective study conducted for a period of two years from 2016 to 2017. Department of Microbiology, Gauhati Medical College and Hospital (GMCH) had received a total of ~12000 and ~9000 sera sample during 2016 and 2017 respectively for confirmation of clinically suspected dengue cases. For confirmation, dengue NS1 antigen and IgM antibody ELISA tests were performed. Multiplex RT-PCR was performed for serotyping of dengue viruses and representative samples found positive in PCR were sequenced to determine the genotypes of circulating dengue virus serotypes. RESULTS: In the year 2016, 6157 sera samples and in 2017, 3386 sera samples were found positive in ELISA test. A total of 157 dengue positive sera samples representing 17 districts of Assam were further tested by multiplex RT-PCR for serotyping of the virus. In PCR, out of 157, 107 samples (68.15%) were found positive for the presence of dengue virus genome. Out of 107, 74 samples (69.15%) were positive for dengue virus serotype-1 (DENV-1), 32 samples (29.90%) for dengue virus serotype-2 (DENV-2) and one sample (0.93%) positive for dengue virus serotype-3 (DENV-3). Out of 107 PCR positive samples, 25 samples were sequenced to identify their genotypes. Phylogenetic analysis of sequenced dengue viruses revealed that all the seven DENV-1 strains were genotype V, 17 DENV-2 strains were genotype IV (Cosmopolitan genotype) and one DENV-3 strain was genotype III. INTERPRETATION & CONCLUSION: These findings improve our knowledge of circulating dengue virus serotypes in Assam. Co-circulation of three serotypes of dengue virus highlights the need for establishment of active dengue surveillance. The genotypic data of our findings will be helpful for future dengue molecular epidemiology studies and to control the disease in the region.

Clinical Profile of Early Childhood Epilepsy: A Cross Sectional Study in a Tertiary Care Hospital.

Epilepsy is one of the most common chronic neurological disorder in children. Incidence is highest in children less than 3 years of age. This cross sectional study was conducted at outpatient department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2010 to December 2010 to explore clinical profile of early childhood epilepsy. Total 50 Children with two or more unprovoked seizure after 28 days up to 36 months of age were included in this study. Majority cases were in the age group of 1 to 12 months (56%) with male predominance (78%). Onset of first seizures was found to be the highest at the age group 0-1 month (50%) with generalized seizures (66%) as the most common type of initial seizures. Highest 16(32%) patients presented with tonic clonic seizure followed by clonic seizure in 15(30%) and tonic in 11(22%) patients. Myoclonic seizure was found to be 4(8%). Only 4(8%) cases were presented with infantile spasm. Majority cases were associated with cerebral palsy (72%). Family history of epilepsy was present in 16%. EEG was done in all patients. Among them 62% were abnormal. Total 21 cases had done CT scan of brain. Among them 6(28.6%) were normal and 15(71.4%) were abnormal. The abnormal findings were cerebral atrophy 73.3%, ventricular dilatation 13.3%, encephalomalacia 6.7% and cerebral infractions were found in 26.7%. In this study majority of cases in 22(44%) were treated with Phenobarbitone (PHB) as a first line drug followed by Valproate (VPA) in 19(38%). Limited study has been conducted on early childhood epilepsy in Bangladesh. The result of this study might be helpful for further large scale study in the field of early childhood epilepsy.

A Rare Case of Metachromatic Leukodystrophy Confirmed by Arylsulfatase A.

Metachromatic leukodystrophy (MLD) is the rare neurometabolic disease caused by the deficiency of a lysosomal enzyme arylsulfatase A (ARSA) activity. The absence or deficiency of arylsulfatase a leads to accumulation of cerebroside sulfate within the myelinseath of the central nervous system (CNS) and the peripheral nervous system (PNS). This in turn causes the CNS and PNS to progressively deteriorate leading to both features of upper and lower motor neuron dysfunctions. Metachromatic leukodystrophy gets its name from the way cells with an accumulation of salfatides appear when viewed under a microscope. The salfatides form granules that are described as metachromatic which means they pick up colour differently than surrounding cellular material when stained for examination. The clinical features of brain dysfunction like gait disturbance, speech, hearing and visual problems appear gradually, become progressive and fatal over time. Our patient a 5 years and 6 months old developmentally normal boy presenting walking difficulty since his 2 years and 6 months which was gradually increasing. During this period he also developed speech difficulty, seizure followed by unconsciousness and severe respiratory distress for ten days. His investigations were suggestive of metachromatic leukodystrophy. There is no specific treatment to cure the disease. So proper counseling was done regarding the bad prognosis of the disease with symptomatic treatment.

Neurologic manifestations, diagnosis and management of Wilson's disease in children - an update.

Wilson's disease (WD) is a genetic disorder of copper (Cu) metabolism. It is a progressive hepatolenticular degenerative disease due to toxic accumulation of copper in the various tissues particularly in the liver, brain and eyes. The neurologic manifestations of Wilson's disease are extremely varied like simple behavioral change such as irritability, depression, deterioration of school performance to severe form of neurologic presentations like dystonia, dysarthria, tremor and gait disturbance. Early diagnosis is possible by history of progressive neurologic dysfunction, clinical examination of Kayser Flescher rings (K-F rings) in eyes, along with some important investigations like low serum ceruloplasmin, high 24 hours urinary excretion of copper, presence of basal ganglia lesion in neuro imaging of the brain. Though hepatic copper estimation done by liver biopsy is the gold standard, is not available in Bangladesh. Most of the neurodegenerative diseases have no specific treatment and worse outcome. But it has a specific treatment with life long medication that reduces copper absorption or removes the excess copper from the body. Children on therapy must be monitored regularly for response, side effects and compliance. The aim of this article is to gather update information of neurologic manifestations of Wilson's disease and proper management as well to prevent the major neurological complications and better out come.

Congenital hypertrichosis (Were Wolf Syndrome): a case report.

Hypertrichosis is abnormal increase in body hair, when it becomes extensive known as Were Wolf Syndrome. Any part of body can be affected and body hairs are longer and darker. Hairs may be of any type like lanugo, vellous or terminal. It may be present since birth or may occur later in life. A 8 years old boy was admitted in our hospital with excess body hair, he was diagnosed as a case of Were Wolf syndrome after excluding possible acquired causes of hypertrichosis. He had history of delayed developmental milestone and has been suffering from epilepsy. He was treated with developmental stimulation and anti epileptic drug. Then he was discharged after proper counseling.

Structural lesion in the brain is a risk factor of childhood intractable epilepsy.

Most of the intractable epilepsy cases are of paediatric age group. Eighty per cent of intractable epilepsy is symptomatic and have got structural lesion. These lesions are easily detectable by doing neuro-imaging. One hundred and four children with epilepsy were enrolled in two groups; in group A 52 intractable epilepsy patients and in group B 52 well controlled epilepsy patients from the child neurology unit of Bangabandhu Sheikh Mujib Medical University. Mean age of intractable group and well-controlled group was 4.45±3.66 years and 6.45±5.24 years respectively. Male were more in both groups. Abnormal neuro-imaging was significantly higher in intractable group; 78.8% children of the intractable epilepsy group had one or more structural lesions. Cortical atrophy, ventricular dilatation and encephalomalacia were the most frequent detectable lesions. Bilateral lesions and presence of multiple abnormalities were more in association with intractability. Structural lesions were detected more in cases with focal neurological deficit and structural abnormality having statistically significant difference.

Demography and Symptom Profile of Tetanus: A Cross-sectional Observation in an Infectious Disease Hospital of Bangladesh.

Tetanus is a potentially preventable neurological infectious disorder with paucity of literature in Bangladesh. We aimed to see the demography and symptom profile of tetanus cases managed at the Infectious disease Hospital Sylhet. This hospital based cross-sectional descriptive study was conducted within the time period of January to December 2012 among 50 consecutive admitted patients in the Infectious Disease Hospital, Sylhet, Bangladesh who were diagnosed as a case of tetanus and fulfilling the inclusion criteria and exclusion criteria. Neonatal tetanus was considered as exclusion criteria and clinical diagnosis of tetanus was considered as the tetanus. Data were collected purposively with pretested predesigned questionnaire. Data were processed manually and analyzed with the help of SPSS Version 16.0. The mean±SD age was 33.00±16.8 years, ranging from 10 to 70 years. Among the 50 respondents, 72.0% were male, 50% from lower class, 34% were students and 30.0% had their educational status of primary level, 60.0% from rural social background. Trismus was found in 98.0% of the cases, rigidity in 96.0% cases, body ache in 94.0% cases, dysphagia in 92.0% cases, neck pain in 78.0% cases, dysarthria in 92.0% cases, reflex spasm in 66.0% cases, opisthotonus in 46.0% cases and urinary retention in 26.0% cases. In this study rural male people with lower socioeconomic status individuals were mostly affected with trismus, rigidity, body ache and dysphagia symptoms.

Gender Difference of Common Risk Factors and in Hospital Outcome of Acute Ischaemic Stroke.

This was an observational study with cross-sectional comparison of risk factors between sexes in the distribution of common risk factors and in hospital outcome of acute ischaemic stroke with the purpose of developing optimal strategies for the prevention and care of this disease. This study was conducted in the Department of Medicine and Department of Neurology, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from March 2013 to August 2013. Patients were divided in Group A- male patients with acute ischaemic stroke (n=47) and Group B- female patients with acute ischaemic stroke (n=47), were included according to inclusion and exclusion criteria. Male were more frequently diabetic [19(40.4%) vs. 10(21.3%), p=0.044] and smoker [41(87.2%) vs. 18 (38.3%); p<0.001] than that of female. Female were older [67.4±8.9 years vs. 62.2±8.1 years; p<0.05]; more frequent hypertensive [36(76.6%) vs. 26(55.3%); p=0.030] than that of male but no gender differences in atrial fibrillation, ischemic heart disease, dyslipidaemia. In-hospital functional outcome (p=0.039) was significantly better in male than that of female patients with acute ischaemic stroke. Characterization of risk factors for acute ischaemic stroke in both sexes may aid in developing prevention strategies to reduce stroke incidence.

Prevalence and Common Risk Factors of Hypertension among School Children Aged 12-16 Years in Sylhet Metropolitan City, Bangladesh.

Hypertension is a common disease associated with high mortality and morbidity. Hypertension could have its origin in childhood and go undetected unless specially looked for during this period. With globalization bringing more lifestyle modifications, adolescents are exposed to multiple risk factors including obesity, diet, academic stress, lack of physical work apart from hereditary risk factors. Early diagnosis of hypertension is an important strategy in its control, effective treatment and prevention of complications. This cross sectional descriptive study was conducted in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from January 2014 to June 2014. One thousand (1000) school children aged 12-16 years in Sylhet Metropolitan City were included according to inclusion and exclusion criteria. Inclusion criteria were all school children aged 12-16 years in Sylhet Metropolitan City. School children aged under 12 or above 16 years and with any systemic disorder were excluded. This study showed that prevalence of hypertension in school going children of Sylhet city was 0.70% and there was a significant relationship of hypertension with the obesity, family history of hypertension, dietary habit and physical activity. Among 7 (seven) hypertensive children, 3(42.8%) were over weight and 3(42.8%) obese (p=0.001). All of 7(100%) children had family history of hypertension (p=0.001). Dietary habit were found healthy in 1(14.3%) and unhealthy in 6(85.7%) (p=0.001). Among 7 positive respondent, 6(85.7%) was sedentary working and 1(14.3%) was inactive (p=0.001). While waist hip ratio among those, 2(28.6%) were excellent and 5(71.4%) were average; was not significant (p=0.745). Prevalence of hypertension in apparently healthy school going children of Sylhet city was 0.70% and this had a strong relationship with obesity, family history of hypertension, dietary habit and physical activity.

Abandonment and Outcome of Childhood Acute Myeloid Leukemia in A Tertiary Level Hospital.

Acute leukemias are the most common child hood malignancy, of which acute myeloid leukemia (AML) are 15 to 20%. Abandonment is one of the most important causes of treatment failure in AML in developing countries. Lost to follow-up is also a big problem in low income countries. Many patients stop therapy soon after diagnosis due to cost, distance and ignorance. To determine the abandonment, outcome and treatment related mortality (TRM) and morbidity among children with AML. This prospective observational study was conducted in the Department of Pediatric hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from February 2013 to January 2014. Fifty (50) patients of AML visited to out patient department (OPD) of Pediatric hematology and Oncology. Among them 11(22%) patients refuse treatment from outdoor. Thirty nine (78%) patients of AML were selected as per inclusion and exclusion criteria. After proper evaluation and clinical examination of these patients, CBC and Bone marrow examination was done for confirmation of diagnosis. A total of 39 patients were recruited in this study. Seventeen (43.6%) patients were male and 22(56.4%) were female. Mean±SD of age was 7.80±4.42 years and range was 1 year to 18 years. Out of 39 patients, 18(46.1%) patients were abandoned, 15(38.4%) expire, relapse 2(5.2%) & alive 4(10.3%). High abandonment (46.1%) and treatment related toxic death (38.4%) has compromised the outcome of acute myeloid leukemia. However AML can be treated with better outcome if improved the supportive care, reduce toxic death, refusal or abandonment.

Tumor Lysis Syndrome and Hyperleukocytosis in Childhood Acute Lymphoblastic Leukemia in a Tertiary Care Hospital.

Acute lymphoblastic leukemia is the most common (77%) childhood leukemia and also the most common neoplastic disease in children. Acute lymphoblastic leukemia initially present with hyperleukocytosis (WBC count more than 50,000/mm³) in twenty percent cases. These children are particularly at risk of development of tumor lysis syndrome (TLS). Tumor lysis syndrome is a metabolic disorder consists of hyperuricaemia, hyperkalemia, hyperphosphataemia, hypocalcaemia with or without renal insufficiency. It is the most common disease related emergency encountered by physicians caring for cancer of children and adult. This cross sectional observational study was conducted in Department of Paediatric Haemato-oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from November 2011 to April 2012 and was designed to assess early biochemical changes associated with hyperleukocytosis which may follow tumor lysis syndrome. Children with Acute lymphoblastic leukemia with hyperleukocytosis who are potential to develop tumor lysis syndrome were selected for the study in their initial presentation. Thirty patients with newly diagnosed acute lymphoblastic leukemia with initial high WBC count; more than 50,000/mm³ were selected for the study. The objectives of the study were to observe the development of tumor lysis syndrome with hyperleukocytosis, detection of early signs of electrolyte changes and early detection of tumor lysis syndrome which can help further in the management of such patients. Majority of the cases were in age group 7 years to 15 years with male predominance (83%). Hyperphosphataemia (80%) followed by hyperuricaemia (53%) were the most common biochemical findings. Hyperkalemia and hypocalcaemia were present in 33% and 26% patients. Laboratory tumor lysis syndrome was developed in 40% of patients and clinical tumor lysis syndrome was developed in 20% patients with hyperleucocytosis meeting the criteria for definition of tumor lysis syndrome by Cairo Bishop in 2004. It was observed that TLS increased with higher WBC. Tumor lysis syndrome developed in 26% patients with WBC count below one lac, 50% with WBC count 1 lac to 2 lacs and increasing upto 100% with WBC count more than 3 lacs. Developing tumor lysis syndrome in high LDH (44% when LDH is more than 1000 unit/l) was also observed.