Setting priorities for a research agenda to combat drug-resistant tuberculosis in children

Setting: Numerous knowledge gaps hamper the prevention and treatment of childhood drug-resistant tuberculosis (TB). Identifying research priorities is vital to inform and develop strategies to address this neglected problem.Objective: To systematically identify and rank research priorities in childhood drug-resistant TB.Design: Adapting the Child Health and Nutrition Research Initiative (CHNRI) methodology, we compiled 53 research questions in four research areas, then classified the questions into three research types. We invited experts in childhood drug-resistant TB to score these questions through an online survey.Results: A total of 81 respondents participated in the survey. The top-ranked research question was to identify the best combination of existing diagnostic tools for early diagnosis. Highly ranked treatment-related questions centred on the reasons for and interventions to improve treatment outcomes, adverse effects of drugs and optimal treatment duration. The prevalence of drug-resistant TB was the highest-ranked question in the epidemiology area. The development type questions that ranked highest focused on interventions for optimal diagnosis, treatment and modalities for treatment delivery.Conclusion: This is the first effort to identify and rank research priorities for childhood drug-resistant TB. The result is a resource to guide research to improve prevention and treatment of drug-resistant TB in children.     

Green synthesis of titanium dioxide nanoparticles using Psidium guajava extract and its antibacterial and antioxidant properties

Objective:To determine the efficacies of antibacterial and antioxidant activities of aqueous leaf extract of Psidium guajava mediated biosynthesis of titanium dioxide nanoparticles(TiO_2,NPs).Methods:Synthesized TiO_2 NPs were tested by disc diffusion method against against human pathogenic bacteria.The total antioxidant activity and phenolic content(Folin—Ciocalteau method) of synthesized TiO_2 NTs and aqueous plant extract were determined.The scavenging radicals were estimated hv DPPH method.The synthesized TiO_2 NPs were characterized by XRD,FTIR.FESEM and EDX,Results:FTIR spectra of synthesized TiO_2 NPs exhibited prominent peaks at 3410 cm~(-1)(alkynes),1 578 cm~(-1).1 451 cm~(-1)(alkanes),and 1 123 cm~(-1)(C-O absorption).The morphological characterization of synthesized TiO_2 NPs was analysed by FESEM which showed spherical shape and clusters with an average size of 32.58 nm.The maximum zone of inhibition was observed in the synthesized TiO_2 NPs(20 μg/mL) against Staphylococcus aureus(25 mm) and Escherichia coli(23 mm).The synthesized TiO_2 NPs showed more antibacterial activity than the standard antibiotic disk,tetracycline which drastically reduces the chances for the development of antibiotics resistance of bacterial species.The plant aqueous extract and synthesized TiO_2NPs were found to possess maximum antioxidant activity when compared with ascorbic acid.The content of phenolic compounds(mg/g) in Leaf aqueous extract and synthesized TiO_2 NPs were found to be 85.4 and 18.3 mgTA/g,respectively.Conclusions:Green synthesized TiO_2 NPs provides a promising approach can satisfy the requirement of large-scale industrial production hearing the advantage of low—cost,eco—friendly and reproducible.     

Early postoperative deaths of recipients after deceased donor liver transplantation

Aim-Background

Liver transplant often results in haemodynamic and biochemical changes in the immediate postoperative period, often causing concern to the treating physician.

The aim

of the present study is to determine the preoperative clinical profile, along with the haematological and biochemical changes following deceased donor liver transplantation (DDLT) in the immediate 7-day postoperative period.

Method

A detailed assessment of the patients preoperative clinical diagnosis, presence of co-morbid illness and postoperative haematological, biochemical, and clinical events was made between survivors and those who died. Various parameters were compared between two groups to help us understand the variants that determined the early postoperative outcome in DDLT patients.

Results

A total of 26 patients were categorized into two groups: 18 patients were allocated to Group 1 (survivors) and 8 patients to Group 2 (mortality). There was no difference in the fluctuation of haemoglobin levels between the two groups. Early leukocytosis and persistent azotemia predicted early morbidity and mortality. A significant fall of platelet count predicted mortality. Transaminases showed a significant increase between the 2^nd and 3rd postoperative day, after which they stabilised and showed a downwards trend by the 7th to 9th postoperative day in both groups. Intraoperative events like cardiac arrhythmias, ischaemic cardiac events, pulmonary thromboembolism, hepatic artery thrombosis, sepsis and multiorgan failure rank among the causes of death.

Conclusion

Preoperative co-morbid illness, postoperative worsening azotemia, persistent leukocytosis, and sepsis and cardiac events in the immediate postoperative period are factors that appear to predict the outcome post DDLT.     

Gossypiboma Presenting as Coloduodenal Fistula – Report of a Rare Case With Review of Literature

The term gossypiboma is used to describe a mass of cotton matrix left behind in a body cavity intraoperatively. The most common site reported is the abdominal cavity. It can present with abscess, intestinal obstruction, malabsorption, gastrointestinal hemorrhage, and fistulas. A 37-year-old woman presented with pain in the right hypochondrium for 2 months following open cholecystectomy. As she did not improve with proton pump inhibitors, an esophagogastroduodenoscopy (EGD) was done, which showed a possible gauze piece stained with bile in the first part of the duodenum. Contrast-enhanced computed tomography (CECT) of the abdomen revealed an abnormal fistulous communication of the first part of duodenum with proximal transverse colon, with a hypodense, mottled lesion within the lumen of the proximal transverse colon plugging the fistula, suggestive of a gossypiboma. Excision of the coloduodenal fistula, primary duodenal repair, and feeding jejunostomy was done. The patient recovered well and is now tolerating normal diet. Coloduodenal fistula is usually caused by Crohn''s disease, malignancy, right-sided diverticulitis, and gall stone disease. Isolated coloduodenal fistula due to gossypiboma has not been reported in the literature so far to the best of our knowledge. We report this case of coloduodenal fistula secondary to gossypiboma for its rarity and diagnostic challenge.Key words: Surgical sponges, Intestinal fistula, Multidetector computed tomographyThe first report of a coloduodenal fistula was by Haldane in 1862, and it was malignant from the hepatic flexure.¹ Coloduodenal fistula is caused by Crohn''s disease, malignancy, right-sided diverticulitis, and gall stone disease, but isolated coloduodenal fistula due to gossypiboma has not been reported in the literature to the best of our knowledge. Gossypiboma is known to present as intra-abdominal abscess, intestinal obstruction, and fistulization, but coloduodenal fistula has not been reported as a mode of presentation. We report this case of coloduodenal fistula secondary to gossypiboma for its rarity and diagnostic challenge.     

Carcinoma Cecum Presenting as Right Gluteal Abscess Through Inferior Lumbar Triangle Pathway—Report of a Rare Case

Gluteal abscess commonly follows intramuscular injections with contaminated needles. Carcinoma cecum is known to present with pericolic abscess due to microperforations and may rupture intraperitoneally. Gluteal abscess secondary to perforated carcinoma cecum with pericolic abscess is extremely uncommon. A 50-year-old woman who was receiving intramuscular iron injections for anemia presented with a 10 × 10-cm abscess in the right gluteal region and a vague mass in the right iliac fossa. After investigations, a diagnosis of perforated carcinoma cecum with pericolic abscess tracking into the right gluteal region was made, and incision and drainage were done. Fine-needle aspiration cytology from the cecal growth revealed adenocarcinoma. Unfortunately, the patient was not willing to undergo definitive treatment. This case is being reported for its rarity and as an uncommon etiology for a common condition.Key words: Gluteal abscess, Carcinoma cecum, Inferior lumbar triangleGluteal abscess is a common condition and most commonly follows intramuscular injections with contaminated needles.^1,2 Carcinoma cecum is known to present with pericolic abscess due to microperforations and may rupture intraperitoneally. Retroperitoneal abscess is rare with carcinoma cecum. Gluteal abscess secondary to perforated carcinoma cecum with pericolic abscess is extremely uncommon. Here we report a case of carcinoma cecum presenting as right gluteal abscess for its rarity and diagnostic challenge and to review its pathogenesis.     

Effect of green tea extract on advanced glycation and cross-linking of tail tendon collagen in streptozotocin induced diabetic rats.

Diabetes leads to modification of collagen such as advanced glycation and cross-linking which play an important role in the pathogenesis of diabetes mellitus. We have investigated the effect of green tea on modification of collagen in streptozotocin (60 mg/kg body weight) induced diabetic rats. To investigate the therapeutic effect of green tea, treatment was begun six weeks after the onset of diabetes and green tea extract (300 mg/kg body weight) was given orally for 4 weeks. The collagen content, extent of advanced glycation, advanced glycation end products (AGE) and cross-linking of tail tendon collagen were investigated. Green tea reduced the tail tendon collagen content which increased in diabetic rats. Accelerated advanced glycation and AGE in diabetic animals, as detected by Ehrlich's-positive material and collagen linked fluorescence respectively were reduced significantly by green tea. The solubility of tail tendon collagen decreased significantly in diabetic rats indicating a remarkable increase in the cross-linking, whereas green tea increases the solubility of collagen in diabetic rats. The present study reveals that green tea is effective in reducing the modification of tail tendon collagen in diabetic rats. Thus green tea may have a therapeutic effect in the treatment of glycation induced complications of diabetes.     

Green tea attenuates diabetes induced Maillard-type fluorescence and collagen cross-linking in the heart of streptozotocin diabetic rats.

The enhanced myocardial collagen content, collagen glycation and the resulting advanced glycation end products (AGE) which exhibit the characteristics of increased cross-linking are proposed for the stiffness of myocardium in diabetes. To explore the cardioprotective effect of green tea in diabetes, we study the effect of green tea extract on myocardial collagen characteristics in streptozotocin diabetic rats. The effect of green tea on marker enzymes in serum and cardiac tissues were also assayed to understand the extent of protection. Six weeks after the diabetes induction, diabetic rats were treated with green tea extract [300 mg (kg body weight)(-1)day(-1)] for 4 weeks. AGE were determined by fluorescence assay and cross-linking of collagen by solubility measurement while collagen content was measured by biochemical assay. The activities of aspartate transaminase (AST), lactate dehydrogenase (LDH) and creatine kinase (CPK) were measured by biochemical assay. The increase in blood glucose, glycated hemoglobin and systolic blood pressure in diabetic rats were reduced upon green tea treatment. The activities of AST, LDH and CPK were significantly increased in serum whereas decreased in cardiac tissues in diabetic rats representing the cardiac damage. Administration of green tea to diabetic rats significantly ameliorates these enzyme activities. There was no significant difference in the myocardial collagen content among the experimental rats. A significant (P<0.05) increase in collagen linked Maillard-type fluorescence and decrease in collagen solubility in the myocardium of diabetic rats as compared to control rats (0.955+/-0.02 versus 0.683+/-0.04 and 30+/-1.41 versus 45.17+/-1.17, respectively) indicates the increase in advanced glycation end products formation and degree of collagen cross-linking. Green tea administration to diabetic rats significantly (P<0.05) decreased the fluorescence (0.73+/-0.02) whereas increased the solubility of collagen (41.5+/-1.04) indicating the reduction in advanced glycation end products and collagen cross-linking. The present study reveals that green tea by ameliorating myocardial collagen characteristics may provide a therapeutic option in the treatment of cardiovascular complications of diabetes.     

Fast gated EPR imaging of the beating heart: Spatiotemporally resolved 3D imaging of free‐radical distribution during the cardiac cycle

In vivo or ex vivo electron paramagnetic resonance imaging (EPRI) is a powerful technique for determining the spatial distribution of free radicals and other paramagnetic species in living organs and tissues. However, applications of EPRI have been limited by long projection acquisition times and the consequent fact that rapid gated EPRI was not possible. Hence in vivo EPRI typically provided only time‐averaged information. In order to achieve direct gated EPRI, a fast EPR acquisition scheme was developed to decrease EPR projection acquisition time down to 10–20 ms, along with corresponding software and instrumentation to achieve fast gated EPRI of the isolated beating heart with submillimeter spatial resolution in as little as 2–3 min. Reconstructed images display temporal and spatial variations of the free‐radical distribution, anatomical structure, and contractile function within the rat heart during the cardiac cycle. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.     

Oxidative stress–associated hypertension in surgically induced brain injury patients: Effects of β-blocker and angiotensin-converting enzyme inhibitor

BackgroundPostoperative hypertension is a common problem in patients undergoing surgical procedures, and the modification of this response could result in improved surgical outcome. Although it is recognized that the incidence of postoperative hypertension is higher in neurosurgical procedures, mechanisms behind this are not well understood. Oxidative stress is an important component of brain injury, and free radicals can influence blood pressure by a number of mechanisms. This study examined the effect of pretreatment with antihypertensive agents on postoperative hypertension in patients undergoing neurosurgery for supratentorial brain tumors and the role of oxidative stress in the process.MethodsForty-nine consecutive patients who underwent surgery for supratentorial brain tumors were divided in to three groups (control, Tab. Glucose; atenolol; and lisinopril groups). Blood was drawn at three time points (1 d before the surgery, at the time of dura opening, and at the time of extubation). Hemodynamic parameters in all three groups and levels of malondialdehyde, protein carbonyl content, nitrate, and α-tocopherol in serum at various time points were analyzed.ResultsThe results showed that perioperative hemodynamic changes were highly associated with oxidative stress parameters in all the three groups. It was seen that atenolol and lisinopril significantly decreased levels of malondialdehyde, protein carbonyl content, and nitrate in the intraoperative period (P < 0.05), an effect which continued postoperatively.ConclusionsThe results demonstrate that pretreatment with β-receptor blocker (atenolol) or angiotensin-converting enzyme inhibitor (lisinopril) reduces postoperative hypertension in patients undergoing neurosurgery, and inhibition of oxidative stress may be a potential mechanism for this effect.