Fungal symbionts of marine sponges from Rameswaram, southern India: species composition and bioactive metabolites

Ten marine sponge species from Rameswaram, southern India were studied for their filamentous fungal symbionts. The results suggest that fungal symbionts of marine sponges are hyperdiverse. Genera such as Acremonium, Alternaria, Aspergillus, Cladosporium, Fusarium and Penicillium were frequently isolated; no true marine fungal species were present. Species of Aspergillus were dominant and co-dominant in all the sponges screened. The fungal isolates produced antialgal, antifungal, antioxidant, antibiotic, antiinsect metabolites. A few fungi produced acetylcholinesterase inhibitors.     

Clinical review: Independent lung ventilation in critical care

Independent lung ventilation (ILV) can be classified into anatomical and physiological lung separation. It requires either endobronchial blockade or double-lumen endotracheal tube intubation. Endobronchial blockade or selective double-lumen tube ventilation may necessitate temporary one lung ventilation. Anatomical lung separation isolates a diseased lung from contaminating the non-diseased lung. Physiological lung separation ventilates each lung as an independent unit. There are some clear indications for ILV as a primary intervention and as a rescue ventilator strategy in both anatomical and physiological lung separation. Potential pitfalls are related to establishing and maintaining lung isolation. Nevertheless, ILV can be used in the intensive care setting safely with a good understanding of its limitations and potential complications.     

Childhood osteosarcoma of greater wing of sphenoid: case report and review of literature

Primary osteosarcoma of skull base is extremely rare. We present a case of primary osteosarcoma arising in greater wing of sphenoid in a child. Our patient had an incomplete excision after which he received adjuvant chemotherapy and radiotherapy. There was good response to adjuvant chemoradiotherapy and the patient is disease free at a follow-up of 18 months. Treatment of skull base osteosarcomas is difficult, as complete excision is often not possible. To the best of our knowledge, this is the first case of sphenoid wing osteosarcoma in childhood to be reported in literature.     

Ministry of Health Clinical Practice Guidelines: Prevention,Diagnosis and Management of Tuberculosis

The Ministry of Health (MOH) has developed the clinical practice guidelines on Prevention, Diagnosis and Management of Tuberculosis to provide doctors and patients in Singapore with evidence-based treatment for tuberculosis. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Prevention, Diagnosis and Management of Tuberculosis, for the information of SMJ readers. The chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.     

Interstitial brachytherapy vs. intensity-modulated radiation therapy for patients with cervical carcinoma not suitable for intracavitary radiation therapy

PurposeInterstitial brachytherapy (IBT) is the standard alternative treatment for patients with cervical carcinoma not suitable for intracavitary radiotherapy. There is an emerging belief that intensity-modulated radiotherapy (IMRT) has the potential to replace IBT. We aimed to compare the dosimetry achieved by IBT and IMRT in such patients.Methods and MaterialsThe CT imaging data, previously used for IBT planning of 12 patients with cervical carcinoma, were transferred to IMRT planning system to generate parallel IMRT plans. Prescribed dose to the planning target volume (PTV) was 20 Gy delivered in 2-weekly high-dose-rate fractions of 10 Gy each with IBT (biologically equivalent dose [BED₁₀] 40 Gy) and 33 Gy/13 fractions/2.5 wk with IMRT (BED₁₀ 41 Gy). For comparison, dose–volume parameters for target and organs at risk were recorded and expressed in terms of BED₁₀ and BED₃, respectively.ResultsFor PTV, the mean D₉₅ (dose received by 95% of PTV) was better with IBT (57.16 Gy vs. 41.47 Gy, p = 0.003). The mean conformity index was 0.94 and 0.90 with IBT and IMRT, respectively (p = 0.034). IBT delivered significantly reduced doses to 1.0 cc (D_max), 5.0 cc (D_{5 cc}), 50% (D₅₀), and 75% (D₇₅) of bladder volume as compared with IMRT. The mean rectal D_max was significantly better with IBT as compared with IMRT (54.64 Gy vs. 62.63 Gy, p = 0.02).ConclusionsIBT provides superior PTV coverage and organs at risk sparing to IMRT. Thus, IBT remains the standard treatment for patients with cervical carcinoma unsuitable for intracavitary radiotherapy.     

Chitinolytic enzymes from endophytic fungi

Fungal endophytes isolated from leaves of tree species of the forests of Western Ghats, southern India were screened for chitin modifying enzyme production. Thirty-one of the one hundred and sixty two isolates were positive for chitinase, while different isolates produced isoforms of the enzyme. Many isolates produced chitosanase that acted on chitosan with different degrees of acetylation. Modified chitin and different types of chitosans are used in biomedical applications including wound healing, drug delivery, gene delivery, tissue engineering, in the food industry as preservatives and emulsifying agents, and in biocatalysis. Horizontally transmitted endophytes appear to be a good source for a variety of chitin modifying enzymes with the potential to be used in biotechnology. The possibility of chitin modifying enzymes of endophytes in regulating plant defense against pathogens and pests in vivo should also be addressed.     

Clinical characteristics and outcome of severe melioidosis requiring intensive care

STUDY OBJECTIVE: To describe the clinical characteristics and outcome of patients with severe melioidosis requiring intensive care. DESIGN: Retrospective chart review. SETTING: Two ICUs from a tertiary-care teaching hospital. PATIENTS: Twenty-seven adult ICU patients with microbiologically documented melioidosis. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The median age was 59 years with a male preponderance (26:1). Twenty patients (74%) had medical comorbidities, with diabetes mellitus being the most common (59.3%). Almost all patients (96.3%) were bacteremic. Twenty patients (74.1%) presented with pneumonia. Twenty patients (74.1%) were in septic shock, and 16 patients (59.3%) had ARDS. Twelve patients (44.4%) required hemodialysis. The patients had a median of three organ dysfunctions, and the median APACHE (acute physiology and chronic health evaluation) II score was 27. The overall mortality was 48.1%. Mortality among patients with septic shock was 60%. The median ICU length of stay for survivors and nonsurvivors was 11 days and 2 days, respectively. Multivariate analysis revealed that the number of organ dysfunctions is an independent predictor of mortality (odds ratio, 8.2; 95% confidence interval, 1.3 to 51.4). CONCLUSIONS: The outcome of severe melioidosis requiring intensive care is poor, with death being predicted by the number of organ dysfunctions.