EVALUATION OF THE ANTIBACTERIAL ACTIVITY OF CALCIUM ALGINATE BEADS MODIFIED WITH ETHANOLIC EXTRACT OF ADHATODA VASICA LEAF EXTRACT ON STAPHYLOCOCCUS AUREUS AND ESCHERICHIA COLI

 Objective: The objective of the present study was to investigate the antibacterial activity of calcium alginate (Ca-ALG) loaded with ethanolic extract of Adhatoda vasica (A. vasica) leaves against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli).Methods: Ca-ALG beads containing ethanolic extract of A. vasica leaves were developed by ionic gelation technique. The prepared Ca-ALG beads were characterized by Fourier-transform infrared (FT-IR) spectroscopy and scanning electron microscopy (SEM). The antibacterial effect of A. vasica leaf extract loaded Ca-ALG beads was examined against S. aureus and E. coli. Results: FT-IR studies revealed the cross-linking of ALG and calcium ions. The spherical morphology of the beads was designated by SEM. The prepared beads were found to display distinctive growth inhibition against S. aureus and E. coli.Conclusion: The antibacterial activity analysis indicated that the prepared beads have good activity against S. aureus and E. coli. The present study proposes a strategy to enhance antibacterial properties of ALG which are widely used in biomedical applications

Predicting chronic postoperative pain after total knee replacement surgery in patients with knee osteoarthritis

We hypothesise that preoperative pain characteristics in knee osteoarthritis (OA) patients may explain persistent pain after total knee replacement (TKR) surgery. Fifty patients awaiting TKR surgery and twenty-two asymptomatic healthy controls were recruited to evaluate the degree of neuropathic pain symptoms and central sensitisation of pain. OA patients were pain phenotyped into two groups based on the PainDETECT questionnaire: Group-A (scores ≥19) indicating neuropathic pain-like symptoms, Group-B (scores <19) indicating nociceptive or mixed pain. Controls were assigned to Group-C. Cuff algometry assessing pain detection thresholds (PDT) and pain tolerance (PTT) was conducted on the lower legs. Temporal summation of pain (TSP) was assessed using ten sequential cuff stimulations set at the subject's individual PTT and a von Frey stimulator. Conditioning pain modulation (CPM) was assessed by cuff pain conditioning on one leg and parallel assessment of PDT on the contralateral leg. Pressure pain thresholds (PPTs) were recorded by pressure handheld algometry local and distant to the knee. Knee pain intensity assessed using the visual analogue scale (VAS score (0-10cm) as well as questionnaires to assess knee function, depression, anxiety, pain catastrophizing and quality of life were collected before and 6 months post-TKR. 30% of knee OA patients demonstrated neuropathic pain-like symptoms (Group-A). Facilitated TSP and reduced PPTs distant to the knee were found in Group-A compared to Group-B and Group-C (p<0.001). Group-A had higher postoperative VAS scores than Group-B patients (p<0.0001) and facilitated TSP (p=0.022) compared with Group-C. Twenty-eight knee OA patients also agreed to undergo a BOLD functional brain MRI scan preoperatively and again six months post TKR to determine the neural signature of TSP using a novel cuff algometer applied to the gastrocnemius muscle ipsilateral to the arthritic knee. Seventeen age and sex matched healthy volunteers also agreed to be in this study for comparison. All subjects underwent a 3-Tesla knee MRI scan which was graded by 2 independent observers for bone marrow lesions (BMLs), Hoffa Synovitis and effusion synovitis using the MRI Osteoarthritis Knee Score (MOAKS). The OA patients also underwent a metal artefact reduction MRI knee scan six months post TKR to identify if there was a continued or new presence of BMLs, Hoffa-synovitis and effusion synovitis which may contribute to the development of chronic postoperative pain. Our study has demonstrated that 30% of patients with knee OA listed for TKR surgery have neuropathic pain like symptoms. Patients with these symptoms report higher preoperative pain with longer pain duration, increased anxiety levels, poor knee function and lower quality of life measures prior to TKR surgery. The same patients respond less favourably to TKR surgery with significantly higher postoperative VAS pain scores, continued pain sensitization (lower PPTs, facilitated TSP and impaired CPM), scores, lower Oxford Knee Scores and quality of life. Increased neural brain activity in the somatosensory region S2 of the brain was found to be an imaging biomarker in central sensitization in knee OA patients. This neural activity is stimulated by chronic Hoffa-synovitis in the knee driving facilitation of the central integrative mechanisms of pain. Responders to TKR normalize their brain related activity with similar neural pattern to the healthy volunteers and show no evidence of central sensitization assessed using quantitative sensory testing (QST). Non-responders to TKR continue to report significant postoperative pain, lower Oxford Knee Scores, continued facilitated TSP, increased S2 neural brain activity along with postoperative BMLs and synovitis that may drive their postoperative pain. This thesis has identified the neural signature of TSP in knee OA patients and shown that brain related changes to TSP are maintained in patients with chronic postoperative pain after TKR. Preoperative identification of OA patients with central sensitization pain and subsequent pharmacological and behavioural therapy along with the eradication of painful BMLs and synovitis may significantly reduce the number of patients developing postoperative pain after TKR surgery

Resection and resolution of bone marrow lesions associated with an improvement of pain after total knee replacement: a novel case study using a 3-Tesla metal artefact reduction MRI sequence

We present our case report using a novel metal artefact reduction magnetic resonance imaging (MRI) sequence to observe resolution of subchondral bone marrow lesions (BMLs), which are strongly associated with pain, in a patient after total knee replacement surgery. Large BMLs were seen preoperatively on the 3-Tesla MRI scans in a patient with severe end stage OA awaiting total knee replacement surgery. Twelve months after surgery, using a novel metal artefact reduction MRI sequence, we were able to visualize the bone-prosthesis interface and found complete resection and resolution of these BMLs. This is the first reported study in the UK to use this metal artefact reduction MRI sequence at 3-Tesla showing that resection and resolution of BMLs in this patient were associated with an improvement of pain and function after total knee replacement surgery. In this case it was associated with a clinically significant improvement of pain and function after surgery. Failure to eradicate these lesions may be a cause of persistent postoperative pain that is seen in up to 20% of patients following TKR surgery

Monoculture vs mixed-species plantation impact on the soil quality of an ecologically sensitive area

Over the past four decades Western Ghats, one of the eight hottest hotspots of biological diversity in the world, has witnessed the transformation of its prime forests into other land-use types mainly monoculture plantations. The present study evaluated the impact of conversion of natural forests to mixed-species (teak) and monoculture (rubber) plantations on the soil quality of the Typic Plinthohumults soil series in the Southern Western Ghats region of Kerala, India. The baseline physicochemical and biological parameters of the different locations were analyzed using standard methods. To comprehend the impact of plantations on the overall soil quality, the soil quality index of the different land-uses was quantified using the forest as the reference land-use Significant variations in different soil physical, chemical, and biological properties of plantation and forest soils were observed in the present study. The overall soil quality index was found to follow the order: forest (1.0) > teak plantations (0.9) > rubber plantations (0.6), thus signifying the negative impact, monoculture rubber plantations had on the soil quality of the study area. The results emphasize the need for the development of better land management practices and mixed-species plantation systems such as the teak plantations in the present study which did not deteriorate the soil quality

Preoperative neuropathic pain like symptoms and central pain mechanisms in knee osteoarthritis predicts poor outcome 6 months after total knee replacement surgery

Preoperative pain characteristics in osteoarthritis (OA) patients may explain persistent pain after total knee replacement (TKR). Fifty patients awaiting TKR and 22 asymptomatic controls were recruited to evaluate the degree of neuropathic pain symptoms and pain sensitisation. OA patients were pain phenotyped into two groups based on the PainDETECT questionnaire: High PainDETECT group (scores ≥19) indicating neuropathic pain-like symptoms, Low PainDETECT group (scores 19) indicating nociceptive or mixed pain.Cuff algometry assessing pain detection thresholds (PDT) and pain tolerance (PTT) was conducted on the lower legs. Temporal summation of pain (TSP) was assessed using ten sequential cuff stimulations and a von Frey stimulator. Conditioning pain modulation was assessed by cuff pain conditioning on one leg and parallel assessment of PDT on the contralateral leg. Pressure pain thresholds (PPTs) were recorded by pressure handheld algometry local and distant to the knee. Knee pain intensity (VAS) and pain assessment were collected before and 6 months post-TKR. 30% of patients demonstrated neuropathic pain-like symptoms (High PainDETECT group). Facilitated TSP and reduced PPTs distant to the knee were found in High PainDETECT group compared to Low PainDETECT group and healthy controls groups (

Earthworm (Clitellata, Megadrili) fauna of Kuttanad wetland, southern part of Vembanad-Kol Ramsar site, India

The earthworm fauna of the wetlands of India is highly undocumented. We have carried out a survey of earthworms in the Kuttanad wetland, an integral part of the Vembanad-Kol Ramsar Site, India’s largest wetland of international importance. Current investigation has documented 17 species belonging to 7 families. Megascolex travancorensis pentagonalis Stephenson, 1916 and Glyphidrilus fluviatilis Rao, 1922 were reported for the first time since their original descriptions. Based on the current study, M. t. pentagonalis is raised to species rank as M. pentagonalis from the subspecies status. G. fluviatilis and Lennogaster chittagongensis (Stephenson, 1917) are new records for the state of Kerala. Present results provide a more complete picture of the earthworm fauna of Kuttanad wetland

Scrub typhus in South India: clinical and laboratory manifestations, genetic variability, and outcome

SummaryObjectivesThis study sought to document the clinical and laboratory manifestations, genetic variability, and outcomes of scrub typhus, an often severe infection caused by Orientia tsutsugamushi, in South India.MethodsPatients admitted to a large teaching hospital with IgM ELISA-confirmed scrub typhus were evaluated. Clinical examination with a thorough search for an eschar, laboratory testing, chest X-ray, and outcome were documented and analyzed. Additionally, a 410-bp region of the 56-kDa type-specific antigen gene of O. tsutsugamushi was sequenced and compared with isolates from other regions of Asia.ResultsMost of the 154 patients evaluated presented with fever and non-specific symptoms. An eschar was found in 86 (55%) patients. Mild hepatic involvement was seen in most, with other organ involvement including respiratory, cardiovascular, and renal. Multi-organ dysfunction was noted in 59 (38.3%), and the fatality rate was 7.8%. Hypotension requiring vasoactive agents was found to be an independent predictor of mortality (p<0.001). The phylogeny of 26 samples showed 17 (65%) clustering with the Kato-like group and eight (31%) with the Karp-like group.ConclusionsThe presentation of scrub typhus can be variable, often non-specific, but with potentially severe multi-organ dysfunction. Prompt recognition is key to specific treatment and good outcomes. Further study of the circulating strains is essential for the development of a successful vaccine and sensitive point-of-care testing

Risk Factors for MDR and XDR-TB in a Tertiary Referral Hospital in India

BACKGROUND: India has a high burden of drug resistant TB, although there are few data on XDR-TB. Although XDR-TB has existed previously in India, the definition has not been widely applied, and surveillance using second line drug susceptibility testing has not been performed. Our objective was to analyze clinical and demographic risk factors associated with isolation of MDR and XDR TB as compared to susceptible controls, at a tertiary center. METHODOLOGY/FINDINGS: Retrospective chart review based on positive cultures isolated in a high volume mycobacteriology laboratory between 2002 and 2007. 47 XDR, 30 MDR and 117 susceptible controls were examined. Drug resistant cases were less likely to be extrapulmonary, and had received more previous treatment regimens. Significant risk factors for XDR-TB included residence outside the local state (OR 7.43, 3.07-18.0) and care costs subsidized (OR 0.23, 0.097-0.54) in bivariate analysis and previous use of a fluoroquinolone and injectable agent (other than streptomycin) (OR 7.00, 95% C.I. 1.14-43.03) and an initial treatment regimen which did not follow national guidelines (OR 5.68, 1.24-25.96) in multivariate analysis. Cavitation and HIV did not influence drug resistance. CONCLUSIONS/SIGNIFICANCE: There is significant selection bias in the sample available. Selection pressure from previous treatment and an inadequate initial regimen increases risk of drug resistance. Local patients and those requiring financial subsidies may be at lower risk of XDR-TB

CUTANEOUS HYPERPIGMENTATION IN MEGALOBLASTIC ANEMIA: A FIVE YEAR RETROSPECTIVE REVIEW.

Background: Cutaneous hyperpigmentation is an often overlooked clinical sign in megaloblastic anemia (MA) which has been sporadically reported in the literature. Methods: We describe the bone marrow (BM) changes and clinicolaboaratory characteristics of 25 of 198 adult cases (>16 years) with cutaneous hyperpigmentation who underwent BM evaluation for cytopenia (s). Results:  Twenty-one of 25 cases (84%) had MA, while MA without hyperpigmentation occurred only in 12 of remainder 173 cases (P0.05). In six cases where follow-up data were available, there was significant reversal of hyperpigmentation at 12 weeks following parenteral cobalamine therapy. In all five cases with pyrexia, fever subsided after 24 to 72 hours following administration of parenteral cobalamine therapy. Conclusion: Cutaneous hyperpigmentation, pyrexia, and cytopenia (s) are strongly associated with megaloblastic anemia. Knuckle pad hyperpigmentation is much more common than diffuse pigmentation of the palms and/or soles in such patents. A nonsignificant trend towards a greater degree of MA was found in cases with pigmentation of the knuckles