The Mystic Utopia of Tales: A Study on Mythologies and Fairytales

There is a confusion hidden in the readers of literature that mythology and fairytales are somewhat similar and serve the same literary purpose. Both of them owe much to human imagination in terms of their creation and presentation. Since time immemorial, both the genre has been enriching literature, art and creation. The two genres discus about flowery unreal tales, but are they completely unreal? Both have been made used in the artistic and poetic creations but the hairline but serious differences are less discussed. This paper focuses to discus about the two and their range that has not been discovered or not compared with their universal mate.&nbsp

Osteonecrosis of Jaw: Common etiologies, uncommon treatments

Introduction First described in 2002, osteonecrosis of the jaw (ONJ, or avascular necrosis of the jaw) is an uncommon but potentially serious side effect of treatment with bisphosphonates. Although typically identified in patients with multiple myeloma and other malignancies, a few cases have been reported in patients taking bisphosphonates - a potent drug class used in the treatment of osteoclast-mediated bone resorption issues, including postmenopausal osteoporosis, Paget\u27s disease, multiple myeloma, and malignant hypercalcemia. The clinical diagnosis of ONJ can be obscured by jaw pain, abscess, swelling, and fistulas, but exposed bone is a distinctive sign. This reports a case of ONJ secondary to bisphosphonate use in a 65-year-old woman and clinical management complications. Case Presentation A 65-year-old lady with history of age-related osteoporosis and compression fractures on alendronate for 4 years, squamous cell carcinoma of neck status post excision and radiotherapy 11-years prior, Sjogren\u27s syndrome and discoid lupus on hydroxychloroquine, diabetes, hypertension, stroke and multiple dental abscesses presents with persistent neck pain. Initial CT neck with contrast showed diffuse fat stranding. Subsequently, alendronate was discontinued due to jaw necrosis suspicion. Eight months later, repeat CT scan showed new non-mass-like soft tissue thickening in the subcutaneous fat abutting the right anterior mandible with mandibular teeth cavities and periapical lucencies, likely to be periodontal cellulitis versus radiation osteonecrosis. Later, patient complained of a piece of bone penetrating the skin of her chin and presented with continuous drainage from sinus tract in her mandible, which was diagnosed as osteonecrosis attributed to bisphosphonates, previous radiation therapy, and dental abscesses. Patient was started on abaloparatide, an osteo-anabolic medication for osteoporosis and enrolled in hyperbaric oxygen therapy which immensely helped in controlling sinus drainage. Patient is currently awaiting mandibular reconstruction surgery. Discussion ONJ, often associated with pain, swelling, exposed bone, local infection, and pathologic fracture of the jaw, is a rare complication of bisphosphonate therapy. Currently, no prospective data exists to advise the benefits of therapy discontinuation however most clinical practices tend to discontinue at least temporarily. The incidence increases with longer treatment duration, particularly when therapy exceeds four years. Risk factors for developing ONJ while taking bisphosphonates include IV administration, anticancer therapy, dose and duration of exposure, dental extractions/implants, glucocorticoids, smoking, diabetes, and preexisting dental disease. Case reports and series suggest benefit from hyperbaric oxygen therapy in wound healing, pain, and quality of life at three months, however no significant differences exist with outcomes beyond three months. Patients being considered for therapy with a bisphosphonate should be thoroughly evaluated for dental issues, prior to initiating therapy. Conservative management with limited debridement, antibiotic therapy as needed, and topical mouth rinses rather than aggressive surgical resection are recommended. Conservative therapy may result in healing in a significant proportion of patients. Surgical resection of necrotic bone should be reserved for refractory or advanced cases. Providers should remain cautious while prescribing high doses of bisphosphonates in patients with increased risk factors to prevent, timely diagnose and treat this condition. References Edwards BJ, Gounder M, McKoy JM, et al. Pharmacovigilance and reporting oversight in US FDA fast-track process: bisphosphonates and osteonecrosis of the jaw. Lancet Oncol 2008; 9:1166. Khosla S, Burr D, Cauley J, et al. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2007; 22:1479. Hoff AO, Toth BB, Altundag K, et al. Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. J Bone Miner Res 2008; 23:826

Toxoplasmosis in Immunocompetent Military Veteran with Overseas Field Deployment

Introduction: Toxoplasmosis is caused by infection with the protozoan Toxoplasma gondii (T. gondii), an obligate intracellular parasite. T. gondii infects a large portion of the world’s population, but uncommonly causes clinically significant disease. Those that are at greatest risk for more severe disease with toxoplasmosis are the immunologically impaired, fetuses, and newborns. T. gondii infection in immunocompetent patients can present as a self-limiting acute infection, or as an acute systemic disease. There are three main T. gondii genotypes, I, II, and III, with varying geographical prevalence. T. gondii is most commonly acquired via ingestion of infectious oocysts, from the environment, tissue cysts from contaminated food items, vertical transmission, or via organ transplantation from an infected donor. Diagnosis can be made via histological and serologic testing in suspected patients. Seropositive testing should be considered within the clinical context, as IgM antibodies may persist for months to years. IgG antibody avidity patterns further help delineate acute versus chronic infections. Histopathology from tissue biopsy of lymphadenopathy is more commonly pursued to establish diagnosis in immunocompetent patients. Case Report: We present a 37-year-old male who presented to the clinic with persistent bilateral non-tender occipital lymphadenopathy of two months duration. Patient also endorsed an acute fluid filled blister on the penis, recurrent cold sores, and significant fatigue. Review of systems were unremarkable. Patient’s immunizations were up-to-date. Patient is an active military serviceman with history of overseas deployment. Patient reports consuming undercooked meat overseas, as well as game meat preparation while hunting. Similar symptoms were also reported by another fellow veteran. Laboratory studies revealed normal CBC, CMP, and TSH. HIV, gonorrhea, and chlamydia testing were negative. Urology referral found no abnormalities. Aspiration biopsy of the right occipital lymph node demonstrated granulomas and aggregates of histiocytes compatible with reactive hyperplasia. Findings were suggestive of toxoplasmosis and no malignancy was found. Follow up T. gondii serological testing results revealed Ab IgM: 104 AU/ML (reference range 0.0-7.9). Toxoplasma gondii Ab IgG: \u3e400 AU/ML (reference range 0.0-7.1), which were consistent for active infection. Patient was referred to Infectious Disease and supportive therapy was recommended. A three month follow up showed improvement in symptoms. Discussion: Although acute infections with T. gondii in immunocompetent patients typically are self-limiting, more serious systemic infections may occur. A pyrimethamine-containing antibiotic regimen is recommended for treating systemic infections. We propose educating high-risk individuals with appropriate preventive measures, which may be beneficial in preventing Toxoplasmosis

Phenothiazines as a solution for multidrug resistant tuberculosis: From the origin to present

Historically, multiplicity of actions in synthetic compounds is a rule rather than exception. The science of non-antibiotics evolved in this background. From the antimalarial and antitrypanosomial dye methylene blue, chemically similar compounds, the phenothiazines, were developed. The phenothiazines were first recognised for their antipsychotic properties, but soon after their antimicrobial functions came to be known and then such compounds were designated as non-antibiotics. The emergence of highly drug-resistant bacteria had initiated an urgent need to search for novel affordable compounds. Several phenothiazines awakened the interest among scientists to determine their antimycobacterial activity. Chlorpromazine, trifluoperazine, methdilazine and thioridazine were found to have distinct antitubercular action. Thioridazine took the lead as researchers repeatedly claimed its potentiality. Although thioridazine is known for its central nervous system and cardiotoxic side-effects, extensive and repeated in vitro and in vivo studies by several research groups revealed that a very small dose of thioridazine is required to kill tubercle bacilli inside macrophages in the lungs, where the bacteria try to remain and multiply silently. Such a small dose is devoid of its adverse side-effects. Recent studies have shown that the (–) thioridazine is a more active antimicrobial agent and devoid of the toxic side effects normally encountered. This review describes the possibilities of bringing down thioridazine and its (–) form to be combined with other antitubercular drugs to treat infections by drug-resistant strains of Mycobacterium tuberculosis and try to eradicate this deadly disease. [Int Microbiol 2015; 18(1):1-12]Keywords: Mycobacterium tuberculosis · phenotiazines · thioridazine · tuberculosi

Phenothiazines as a solution for multidrug resistant tuberculosis:From the origin to present

Historically, multiplicity of actions in synthetic compounds is a rule rather than exception. The science of non-antibiotics evolved in this background. From the antimalarial and antitrypanosomial dye methylene blue, chemically similar compounds, the phenothiazines, were developed. The phenothiazines were first recognised for their antipsychotic properties, but soon after their antimicrobial functions came to be known and then such compounds were designated as non-antibiotics. The emergence of highly drug-resistant bacteria had initiated an urgent need to search for novel affordable compounds. Several phenothiazines awakened the interest among scientists to determine their antimycobacterial activity. Chlorpromazine, trifluoperazine, methdilazine and thioridazine were found to have distinct antitubercular action. Thioridazine took the lead as researchers repeatedly claimed its potentiality. Although thioridazine is known for its central nervous system and cardiotoxic side-effects, extensive and repeated in vitro and in vivo studies by several research groups revealed that a very small dose of thioridazine is required to kill tubercle bacilli inside macrophages in the lungs, where the bacteria try to remain and multiply silently. Such a small dose is devoid of its adverse side-effects. Recent studies have shown that the (–) thioridazine is a more active antimicrobial agent and devoid of the toxic side effects normally encountered. This review describes the possibilities of bringing down thioridazine and its (–) form to be combined with other antitubercular drugs to treat infections by drug-resistant strains of Mycobacterium tuberculosis and try to eradicate this deadly disease. [Int Microbiol 2015; 18(1):1-12]Keywords: Mycobacterium tuberculosis · phenotiazines · thioridazine · tuberculosi

Waterborne Diseases: Linking Public Health And Watershed Data

Microbial contaminants in water are a major public health concern. Pathogens have been identified as a primary threat to river water quality in the United States, potentially impacting drinking and irrigation water sources and recreational waters. Agricultural runoff, feedlot operations, wastewater effluents, swimming activities, domestic and wild animals are potential sources of microbial contamination. This thesis presents Massachusetts as a case study for linking public health data of waterborne gastrointestinal diseases with sources of drinking water, potential recreational exposures, as well as hydrologic, climatic, and land use data. Giardia sp. has been chosen as a model organism. Information of reported human Giardiasis cases has been synthesized. Using Geological Information system and statistical software (SPSS and SAS) relationships of confirmed Giardiasis have been compared with available climate and hydrologic data. In this thesis the research finding suggest that there is no visible difference in disease occurrence related with amount of precipitation or extreme rain event. However human giardiasis in Massachusetts has been found related with temperature thus shows a seasonal trend in disease occurrence. Seasonal water related human activity likely have played a role in disease occurrence

Involvement of Intracellular Signaling Cascades in Inflammatory Responses in Human Intestinal Epithelial Cells following Vibrio Cholerae Infection

Vibrio cholerae, the etiological agent of cholera, leads to the induction of host cell nuclear responses and the activation of proinflammatory cytokines in the cultured intestinal epithelial cells. However, the host cell signaling pathway leading to proinflammatory response is not explored. In this study, we demonstrated that V. cholerae infection on intestinal epithelial cells results in the activation of extracellular signalregulated kinases1/2(ERK1/2) and p38 of the mitogen activated protein kinase (MAPK) family. V. cholerae induced intracellular pathways in Int407 cells leading to the activation of protein kinase A (PKA) and protein tyrosin kinase (PTK) in upstream of MAPK and nuclear factor-kappaB (NF-�B) pathway. Inhibitor study of Ca2+ and phospholipase-gamma (PLC-�) pathway suggested the possible involvement of Ca2+ signaling in the V. cholerae pathogenesis. V. cholerae culture supernatants as also insertional mutants of ctxA, toxR and toxT genes modulate the activation of MAPK and NF-�B signaling pathways. MAPK and NF-�B signaling pathway activation were also modulated by adherence and motility of V. cholerae. Studies with inhibitor of NF-�B, MAPK, PTK, PKA, PKC, Ca2+ and PLC pathways showed differential cytokine secretion in Int407 following V. cholerae infection. Therefore V. cholerae mediated induction of nuclear responses through signal transduction pathway and subsequent activation of proinflammatory cytokines in Int407 modulated by V. cholerae secretory factors, virulence, adhesion/motility which might explain some of its reactogenic mechanism