Tuboenterocutaneous fistula following caesarean section

Fistulous communication between fallopian tube, sigmoid colon and the skin after caesarean section is an unreported entity so far. Here we report a case of tuboenterocutaneous fistula which developed after wound complication following lower segment caesarean section (LSCS). Computed tomography (CT) was used to diagnose the case and laparotomy was done as definitive surgery

Critical understanding of Rajayakshma Samprapti with special reference to Respiratory Dominant Pulmonary Tuberculosis

Rajyakshma is one among the Asthamahagada explained by Acharya Charaka and termed as king of the disease. It had always been challenge to diagnose and treat due to its syndromic manifestation and also the multisystem involvement. So before planning the treatment it is very necessary to understand the   Nidana and Samprapti in detail. Rajayakshma has been correlated to many Immunodeficiency Syndromes but on critical analysis on symptomatology, it clinically resembles a respiratory dominant multisystem disease. The condition was also identified as an Aupsargika Vyadhi and also a set of predisposing factors i.e., Chaturvidha Nidana. Due to the indulgence in Nidana there is viatiation of Tridoshas and Sapta Dhatu. In modern era Rajyakshma which affecting the Pranavaha Srotas can be correlated to pulmonary tuberculosis. Though there is difference in the pathogenesis of Rajayakshma and pulmonary tuberculosis the clinical picture of both is quite similar. The western medicine deals more with the infective focus, it method of spread and different modalities of diagnosis and standard WHO Antimicrobial agents. Aims and objectives of the paper to express the basic concept of Hetu and Samprapti of Rajayakshma which affecting the Prana Vaha Srotas w.s.r to pulmonary tuberculosis to its full perspective

Drug used pattern by self-medication among the RT-PCR positive health workers in Dhaka city

Background: To date there is no effective treatment against COVID-19. Self-medication played one of the major modes of treatment among general population as well as the health workers during this pandemic. Studying the pattern of self-medication among the health care workers (HCWs) may indicate their knowledge and skills towards rational use of medicines. The aim of the study was to assess the pattern self-medication among the COVID-19 affected HCWs.Methods: This cross-sectional survey assessed the pattern of drug used by self-medication among the health workers who were RT-PCR positive in context to Bangladesh.Results: A total of 267 HCWs data were collected. Most of the HCWs were in middle age group between 31-40 years with the mean age of 32.2±5.2. Doctors (83.9%) enrolled five times more than the nurses (16.1%). Most of the HCWs (60.3%) commenced medications just after appearance of symptoms and 27.0% went for the RT-PCR testing. Only 3.7% went to health care facilities for treatment. More than sixty percent of the respondents took medication by themselves just after start the symptoms, 19 (33.7%) took advised from the specialists and attended at health facilities 2.6%. Most of the patients (42.7%) used azithromycin as antimicrobial agent. Paracetamol was the most used drug among the participants (78.65%) followed by antihistamines (67.79%). Average number of drugs used by patients 3.1% and percentage of antibiotics per patients 42.6%.Conclusions: The prescribing practice of antibiotics shows deviation from the standard recommendation. Awareness regarding essentials drug list should be needed.

SmartHeLP: Smartphone-based Hemoglobin Level Prediction Using an Artificial Neural Network

Blood hemoglobin level (Hgb) measurement has a vital role in the diagnosis, evaluation, and management of numerous diseases. We describe the use of smartphone video imaging and an artificial neural network (ANN) system to estimate Hgb levels non-invasively. We recorded 10 second-300 frame fingertip videos using a smartphone in 75 adults. Red, green, and blue pixel intensities were estimated for each of 100 area blocks in each frame and the patterns across the 300 frames were described. ANN was then used to develop a model using the extracted video features to predict hemoglobin levels. In our study sample, with patients 20-56 years of age, and gold standard hemoglobin levels of 7.6 to 13.5 g/dL., we observed a 0.93 rank order of correlation between model and gold standard hemoglobin levels. Moreover, we identified specific regions of interest in the video images which reduced the required feature space

Highly conserved type 1 pili promote enterotoxigenic E. coli pathogen-host interactions

Enterotoxigenic Escherichia coli (ETEC), defined by their elaboration of heat-labile (LT) and/or heat-stable (ST) enterotoxins, are a common cause of diarrheal illness in developing countries. Efficient delivery of these toxins requires ETEC to engage target host enterocytes. This engagement is accomplished using a variety of pathovar-specific and conserved E. coli adhesin molecules as well as plasmid encoded colonization factors. Some of these adhesins undergo significant transcriptional modulation as ETEC encounter intestinal epithelia, perhaps suggesting that they cooperatively facilitate interaction with the host. Among genes significantly upregulated on cell contact are those encoding type 1 pili. We therefore investigated the role played by these pili in facilitating ETEC adhesion, and toxin delivery to model intestinal epithelia. We demonstrate that type 1 pili, encoded in the E. coli core genome, play an essential role in ETEC virulence, acting in concert with plasmid-encoded pathovar specific colonization factor (CF) fimbriae to promote optimal bacterial adhesion to cultured intestinal epithelium (CIE) and to epithelial monolayers differentiated from human small intestinal stem cells. Type 1 pili are tipped with the FimH adhesin which recognizes mannose with stereochemical specificity. Thus, enhanced production of highly mannosylated proteins on intestinal epithelia promoted FimH-mediated ETEC adhesion, while conversely, interruption of FimH lectin-epithelial interactions with soluble mannose, anti-FimH antibodies or mutagenesis of fimH effectively blocked ETEC adhesion. Moreover, fimH mutants were significantly impaired in delivery of both heat-stable and heat-labile toxins to the target epithelial cells in vitro, and these mutants were substantially less virulent in rabbit ileal loop assays, a classical model of ETEC pathogenesis. Collectively, our data suggest that these highly conserved pili play an essential role in virulence of these diverse pathogens

Outcome after video-assisted thoracoscopic surgery and open pulmonary lobectomy in patients with low VO_{2 max}: a case-matched analysis from the ESTS database

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Resistance pattern and molecular characterization of enterotoxigenic Escherichia coli (ETEC) strains isolated in Bangladesh

Enterotoxigenic Escherichia coli (ETEC) is a common cause of bacterial infection leading to acute watery diarrhea in infants and young children as well as in travellers to ETEC endemic countries. Ciprofloxacin is a broad-spectrum antimicrobial agent nowadays used for the treatment of diarrhea. This study aimed to characterize ciprofloxacin resistant ETEC strains isolated from diarrheal patients in Bangladesh.A total of 8580 stool specimens from diarrheal patients attending the icddr,b Dhaka hospital was screened for ETEC between 2005 and 2009. PCR and Ganglioside GM1- Enzyme Linked Immuno sorbent Assay (ELISA) was used for detection of Heat labile (LT) and Heat stable (ST) toxins of ETEC. Antimicrobial susceptibilities for commonly used antibiotics and the minimum inhibitory concentration (MIC) of nalidixic acid, ciprofloxacin and azithromycin were examined. DNA sequencing of representative ciprofloxacin resistant strains was performed to analyze mutations of the quinolone resistance-determining region of gyrA, gyrB, parC and parE. PCR was used for the detection of qnr, a plasmid mediated ciprofloxacin resistance gene. Clonal variations among ciprofloxacin resistant (CipR) and ciprofloxacin susceptible (CipS) strains were determined by Pulsed-field gel electrophoresis (PFGE).Among 1067 (12%) ETEC isolates identified, 42% produced LT/ST, 28% ST and 30% LT alone. Forty nine percent (n = 523) of the ETEC strains expressed one or more of the 13 tested colonization factors (CFs) as determined by dot blot immunoassay. Antibiotic resistance of the ETEC strains was observed as follows: ampicillin 66%, azithromycin 27%, ciprofloxacin 27%, ceftriazone 13%, cotrimaxazole 46%, doxycycline 44%, erythromycin 96%, nalidixic acid 83%, norfloxacin 27%, streptomycin 48% and tetracycline 42%. Resistance to ciprofloxacin increased from 13% in 2005 to 34% in 2009. None of the strains was resistant to mecillinam. The MIC of the nalidixic acid and ciprofloxacin of representative CipR strains were 256 μg/ml and 32μg/ml respectively. A single mutation (Ser83-Leu) in gyrA was observed in the nalidixic acid resistant ETEC strains. In contrast, double mutation in gyrA (Ser83-Leu, Asp87-Asn) and a single mutation in parC (Glu84-Ly) were found in ciprofloxacin resistant strains. Mutation of gyrB was not found in either the nalidixic acid or ciprofloxacin resistant strains. None of the ciprofloxacin resistant strains was found to be positive for the qnr gene. Diverse clones were identified from all ciprofloxacin resistant strains by PFGE analysis in both CF positive and CF negative ETEC strains.Emergence of ciprofloxacin resistant ETEC strains results in a major challenge in current treatment strategies of ETEC diarrhea

Nitrogen availability prevents oxidative effects of salinity on wheat growth and photosynthesis by up-regulating the antioxidants and osmolytes metabolism, and secondary metabolite accumulation.

Funder: NorthWest A&F University Yaangling, Shaanxi, China.BACKGROUND: Salinity is one of the damaging abiotic stress factor. Proper management techniques have been proposed to considerably lower the intensity of salinity on crop growth and productivity. Therefore experiments were conducted to assess the role of improved nitrogen (N) supplementation on the growth and salinity stress tolerance in wheat by analyzing the antioxidants, osmolytes and secondary metabolites. RESULTS: Salinity (100 mM NaCl) stress imparted deleterious effects on the chlorophyll and carotenoid synthesis as well as the photosynthetic efficiency. N supplementation resulted in increased photosynthetic rate, stomatal conductance and internal CO2 concentration with effects being much obvious in seedlings treated with higher N dose. Under non-saline conditions at both N levels, protease and lipoxygenase activity reduced significantly reflecting in reduced oxidative damage. Such effects were accompanied by reduced generation of toxic radicals like hydrogen peroxide and superoxide, and lipid peroxidation in N supplemented seedlings. Antioxidant defence system was up-regulated under saline and non-saline growth conditions due to N supplementation leading to protection of major cellular processes like photosynthesis, membrane structure and function, and mineral assimilation. Increased osmolyte and secondary metabolite accumulation, and redox components in N supplemented plants regulated the ROS metabolism and NaCl tolerance by further strengthening the antioxidant mechanisms. CONCLUSIONS: Findings of present study suggest that N availability regulated the salinity tolerance by reducing Na uptake and strengthening the key tolerance mechanisms

Examination of the enterotoxigenic Escherichia coli population structure during human infection

Enterotoxigenic E. coli (ETEC) can cause severe diarrhea and death in children in developing countries; however, bacterial diversity in natural infection is uncharacterized. In this study, we explored the natural population variation of ETEC from individuals with cholera-like diarrhea. Genomic sequencing and comparative analysis of multiple ETEC isolates from twelve cases of severe diarrhea demonstrated clonal populations in the majority of subjects (10/12). In contrast, a minority of individuals (2/12) yielded phylogenomically divergent ETEC isolates. Detailed examination revealed that isolates also differed in virulence factor content. These genomic data suggest that severe, cholera-like ETEC infections are largely caused by a clonal population of organisms within individual patients. Additionally, the isolation of similar clones from geographically and temporally dispersed cases with similar clinical presentations suggests that some isolates are particularly suited for virulence. The identification of multiple genomically diverse isolates with variable virulence factor profiles from a single subject highlights the dynamic nature of ETEC, as well as a potential weakness in the examination of cultures obtained from a single colony in clinical settings. These findings have implications for vaccine design and provide a framework for the study of population variation in other human pathogens