Cheap Retrieval Bag for Laparoscopic Cholecystectomy

Gallstone disease is one of the most common gastrointestinal conditions that require surgery and currently laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic cholelithiasis. Use of a laparoscopic bag for facilitating extraction/ morcellation of the operative specimen has been shown to minimize infection of wound and abdominal cavity. Various laparoscopic bag substitutes like latex gloves and glove fingers have been used. We described a sterilized plastic surgical drain cover as a reasonable substitute for retrieving the gallbladder after LC

Mixed Mucinous Carcinoma of the Male Breast

Male breast malignancy is extremely rare, representing less than 1% of all breast carcinomas. Infiltrating duct carcinoma is the commonest subtype. Pure mucinous carcinoma and mixed mucinous carcinoma wherein there are components of both mucinous carcinoma and infiltrating duct carcinoma are rare tumours constituting 1.5-5% in women and are even rarer in men. We present here a case of mixed mucinous carcinoma of the breast with metastasis to axillary lymph nodes in a male patient

Prescribing pattern of antimicrobials in various clinical departments of a tertiary care hospital

Background: Antimicrobials are one of the most commonly used group of drugs. Their overuse and inappropriate use is one of the major concerns today. Assessment of prescribing pattern of antimicrobials provides insight into the health consequences and helps update antimicrobial usage guidelines. Hence this study was conducted with an objective to analyse the prescribing pattern of the antimicrobials.Methods: A cross sectional study was conducted based on the prescriptions collected from Department of Pharmacy, Pondicherry Institute of Medical Sciences (PIMS), Puducherry. A total of 838 outpatient prescriptions were collected from four clinical departments, viz. General Medicine, General Surgery, Pediatrics and Obstetrics & Gynecology for a period of four months. The data collected were analysed using descriptive statistics.Results: Among 838 prescriptions 188 (22.43%) contained antimicrobials. Among the various departments, number of prescriptions with antimicrobials were more in department of General surgery (34.42 %) followed by Obstetrics & Gynecology (24.77 %). The commonly prescribed antibiotics were penicillins (25.47%), fluoroquinolones (12.73%), cephalosporins (10.84%), macrolides (8.96%), nitroimidazoles (6.60%) and tetracyclines (4.71%). Among the total antimicrobials, percentage of drugs prescribed by generic name and from National list of essential medicines (NLEM) were 38.20% and 80.18% respectively. Majority of antimicrobials (58.01%) were prescribed as oral tablets/ capsules.Conclusions: It was found that penicillins were the most commonly prescribed group of antimicrobials, significantly less number of antimicrobials were prescribed by generic name, 80.18% of antimicrobials were prescribed from NLEM and tablets/ capsules were the most common dosage forms

Prescribing pattern of antimicrobials in various clinical departments of a tertiary care hospital

Background: Antimicrobials are one of the most commonly used group of drugs. Their overuse and inappropriate use is one of the major concerns today. Assessment of prescribing pattern of antimicrobials provides insight into the health consequences and helps update antimicrobial usage guidelines. Hence this study was conducted with an objective to analyse the prescribing pattern of the antimicrobials.Methods: A cross sectional study was conducted based on the prescriptions collected from Department of Pharmacy, Pondicherry Institute of Medical Sciences (PIMS), Puducherry. A total of 838 outpatient prescriptions were collected from four clinical departments, viz. General Medicine, General Surgery, Pediatrics and Obstetrics & Gynecology for a period of four months. The data collected were analysed using descriptive statistics.Results: Among 838 prescriptions 188 (22.43%) contained antimicrobials. Among the various departments, number of prescriptions with antimicrobials were more in department of General surgery (34.42 %) followed by Obstetrics & Gynecology (24.77 %). The commonly prescribed antibiotics were penicillins (25.47%), fluoroquinolones (12.73%), cephalosporins (10.84%), macrolides (8.96%), nitroimidazoles (6.60%) and tetracyclines (4.71%). Among the total antimicrobials, percentage of drugs prescribed by generic name and from National list of essential medicines (NLEM) were 38.20% and 80.18% respectively. Majority of antimicrobials (58.01%) were prescribed as oral tablets/ capsules.Conclusions: It was found that penicillins were the most commonly prescribed group of antimicrobials, significantly less number of antimicrobials were prescribed by generic name, 80.18% of antimicrobials were prescribed from NLEM and tablets/ capsules were the most common dosage forms

In silico modeling of Plasmodium falciparum chloroquine resistance transporter protein and biochemical studies suggest its key contribution to chloroquine resistance

Chloroquine (CQ) has been used for decades as the primary chemotherapeutic drug for the treatment of malaria. The emergence of drug resistance in Plasmodium falciparum has been considered to be because of the excessive use of antimalarial drugs worldwide. Moreover, the intense distribution and prevalence of chloroquine-resistant strains in endemic regions has aided the incidence of more complications to malaria treatment and control. Due to the lack of literature that portrays evident molecular mechanisms of drug resistance, it has been difficult to understand the drug resistance conferred by Plasmodium species. Intensive research on CQ drug resistance has identified the association of P. falciparum chloroquine resistance transporter protein (PfCRT), which belongs to the drug/metabolite transporter and EamA-like superfamily. Additionally, it has shown that K76 T mutation in PfCRT protein has mainly attributed to CQ resistance than other mutations. This study deals with the development of an in silica model of the PfCRT protein and its interaction with the CQ ligand molecule as well as the biochemical and biophysical characterization of the transmembrane domain 1 (TMD 1) peptide of the PfCRT protein. The physiochemical analysis of the PfCRT protein identified basic differences between the wild and mutant forms of the protein, as well as identifying the high hydrophobic nature of the mutant-type protein. The tertiary structure of the PfCRT protein was predicted and interaction with CQ revealed different active pocket binding regions in both the wild and mutant form of PfCRT proteins. The CQ2 molecule interacts with TMD 10 of the wild-type PfCRT protein, whereas it interacts with TMD 1 of the mutant-type protein. Studies on the TMD 1 peptide revealed the insertion of the peptide in the micelles adopting stable alpha-helical structure. Binding studies with the CQ molecule detected high binding affinity toward the mutant-type TMD 1 peptide rather than the wild-type, thus confirming that the TMD 1 peptide is involved in substrate selectivity. Our findings help to characterize the structure of the PfCRT protein and the role played by the TMD 1 region in CQ resistance using in silica and biochemical approaches. Molecular docking and ligand binding studies confirm that TMD 1 is involved in substrate selectivity and aids in CQ efflux, thereby contributing to the parasites CQ drug resistance mechanism

Identification of Potential MHC Class-II-Restricted Epitopes Derived from Leishmania donovani Antigens by Reverse Vaccinology and Evaluation of Their CD4+ T-Cell Responsiveness against Visceral Leishmaniasis

Visceral leishmaniasis (VL) is one of the most neglected tropical diseases for which no vaccine exists. In spite of extensive efforts, no successful vaccine is available against this dreadful infectious disease. To support vaccine development, an immunoinformatics approach was applied to screen potential MHC class-II-restricted epitopes that can activate the immune cells. Initially, 37 epitopes derived from six stage-dependent, overexpressed antigens were predicted, which were presented by at least 26 diverse MHC class-II allele. Based on a population coverage analysis and human leukocyte antigen cross-presentation ability, six of the 37 epitopes were selected for further analysis. Stimulation with synthetic peptide alone or as a cocktail triggered intracellular IFN-γ production. Moreover, specific IgG antibodies were detected in the serum of active VL cases against P1, P4, P5, and P6 in order to evaluate the peptide effect on the humoral immune response. Additionally, most of the peptides, except P2, were found to be non-inducers of CD4+ IL-10 against both active VL as well as treated VL subjects. This finding suggests there is no role of these peptides in the pathogenesis of Leishmania. Peptide immunogenicity was validated in BALB/c mice immunized with a cocktail of synthetic peptide emulsified in complete Freund’s adjuvant/incomplete Freund’s adjuvant. The immunized splenocytes induced strong spleen cell proliferation upon parasite re-stimulation. Furthermore, increased IFN-γ, interleukin-12, IL-17, and IL-22 production augmented with elevated nitric oxide (NO) synthesis is thought to play a crucial role in macrophage activation. In this investigation, we identified six MHC class-II-restricted epitope hotspots of Leishmania antigens that induce CD4+ Th1 and Th17 responses, which could be used to potentiate a human universal T-epitope vaccine against VL

Snowball Vs. House-to-House Technique for Measuring Annual Incidence of Kala-azar in the Higher Endemic Blocks of Bihar, India: A Comparison.

Visceral Leishmaniasis, commonly known as kala-azar, is widely prevalent in Bihar. The National Kala-azar Control Program has applied house-to-house survey approach several times for estimating Kala-azar incidence in the past. However, this approach includes huge logistics and operational cost, as occurrence of kala-azar is clustered in nature. The present study aims to compare efficiency, cost and feasibility of snowball sampling approach to house-to-house survey approach in capturing kala-azar cases in two endemic districts of Bihar, India.A community based cross-sectional study was conducted in two highly endemic Primary Health Centre (PHC) areas, each from two endemic districts of Bihar, India. Snowball technique (used to locate potential subjects with help of key informants where subjects are hard to locate) and house-to-house survey technique were applied to detect all the new cases of Kala-azar during a defined reference period of one year i.e. June, 2010 to May, 2011. The study covered a total of 105,035 households with 537,153 populations. Out of total 561 cases and 17 deaths probably due to kala-azar, identified by the study, snowball sampling approach captured only 221 cases and 13 deaths, whereas 489 cases and 17 deaths were detected by house-to-house survey approach. Higher value of McNemar's χ² statistics (64; p1) indicates that most of the kala-azar cases missed by snowball sampling were captured by house-to-house approach with 13% of omission.Snowball sampling was not found sensitive enough as it captured only about 50% of VL cases. However, it captured about 77% of the deaths probably due to kala-azar and was found more cost-effective than house-to-house approach. Standardization of snowball approach with improved procedure, training and logistics may enhance the sensitivity of snowball sampling and its application in national Kala-azar elimination programme as cost-effective approach for estimation of kala-azar burden