Severe localized re-expansion pulmonary oedema: An unusual instance

A lobar re-expansion pulmonary oedema (REPO) after pleural drainage procedure is rare and usually asymptomatic. We report a 56-year-old man with severe left lower lobar REPO after tube thoracostomy drainage of a loculated hydro-pneumothorax of 2 days' duration with underlying chronic obstructive pulmonary disease. The clinical manifestations were immediate and disproportionate to the radiological extent of REPO. The severity of lobar REPO was probably related to the pre-existing emphysematous changes and airway obstruction. Supplemental oxygen and intermittent pleural drainage led to clinical recovery within 24 hours, followed by radiological clearance of alveolar opacities within 3 days.

Bacteriological profile of neonatal septicemia and antibiotic susceptibility pattern of the isolates

Context:

Septicemia in neonates refers to generalized bacterial infection documented by positive blood culture in the first four weeks of life and is one of the four leading causes of neonatal mortality and morbidity in India.

Aim:

To isolate and identify the bacterial etiologic agents responsible for neonatal sepsis and to determine the susceptibility pattern of isolates in a tertiary care hospital in North Karnataka.

Materials and Methods:

Six hundred eighty-three blood samples were collected and processed from patients in accordance with standard protocols. Antibiotic susceptibility of the isolates was done by disc diffusion method according to National Committee for Clinical Laboratory Standards (NCCLS) recommendations.

Results:

Blood culture reports were positive in 19.2% cases. Among the culture positive cases, there were 65.5% males and 34.5% females. Early-onset sepsis was present in 74.8% and late-onset sepsis was observed in 25.2% of the cases. Best overall sensitivity among Gram-negative isolates was to imipenem (93%), followed by amikacin (52%) and netilmicin (41%). Gram-positive isolates had sensitivity of 91% to linezolid, 68% to tetracycline, 64% to piperacillin/tazobactam erythromycin, and 52% to ciprofloxacin.

Conclusion:

Gram-negative organisms (Klebsiella, Acinetobacter), coagulase-negative staphylococci, and Staphylococcus aureus are the leading cause of neonatal sepsis in this study and most of them are resistant to multiple antibiotics. Therefore the results of this study suggest that, surveillance of antimicrobial resistance in our hospital is necessary.

Anti-microbial resistance profile of Citrobacter species in a tertiary care hospital of Southern India

BACKGROUND

Recently, the isolation of this pathogen in hospital settings is increasing and multidrug-resistant strains are emerging; these strains present a challenge for clinician and the clinical microbiologist because of their increased occurrence in nosocomial infection. The current study was done to find out the antibiotic sensitivity pattern of Citrobacter species from various clinical specimens.

MATERIALS AND METHODS

Samples were collected from patients in accordance with standard protocols. Citrobacter species were identified by conventional biochemical tests. Antibiotic susceptibility of the isolates was done by disc diffusion method according to National Committee for Clinical Laboratory Standards (NCCLS) recommendations.

RESULTS

Out of 563 isolates of Citrobacter, majority were from pus (48.1%), followed by urine (24.3%), sputum (20.3%), body fluids (05.2%), blood (02.1%). C. koseri was the predominant species [391 (70%)] isolated. Infection was nosocomialy acquired in 493 (87.4%) patients. The mean age was 39.5 years. Anti-biograms of Citrobacter isolates revealed that effective agent against Citrobacter isolates was imipenem (91.8% sensitive), followed by piperacillin/tazobactam (58.3%) and amikacin (53.4%).

CONCLUSION

Citrobacter isolates resistant to multiple anti-microbial agents have emerged, including strains resistant to imipenem, making it an emerging nosocomial pathogen. Therefore, the results of this study suggest that surveillance of anti-microbial resistance in Citrobacter is necessary. Antibiotic policy should be formulated in the hospital. Depending on the antibiotic sensitivity pattern of the Citrobacter isolates, antibiotics should be used, and proper infection control measures should be strictly followed to prevent spread of this pathogen.

A study of oxidative stress in paucibacillary and multibacillary leprosy

BACKGROUND

The study and assessment of oxidative stress plays a significant role in the arena of leprosy treatment. Once the presence of oxidative stress is proved, antioxidant supplements can be provided to reduce tissue injury and deformity.

AIM

To study oxidative stress in paucibacillary (PB) and multibacillary (MB) leprosy and to compare it with that in a control group.

METHODS

Fifty-eight untreated leprosy patients (23 PB and 35 MB cases) were studied and compared with 58 healthy controls. Superoxide dismutase (SOD) level as a measure of antioxidant status; malondialdehyde (MDA)level, an indicator of lipid peroxidation; and MDA/SOD ratio, an index of oxidative stress were estimated in the serum.

RESULTS

The SOD level was decreased in leprosy patients, especially in MB leprosy. The MDA level was increased in PB and MB leprosy. The MDA/SOD ratio was significantly elevated in MB patients. There was a steady increase in this ratio along the spectrum from tuberculoid to lepromatous leprosy (LL).

CONCLUSION

There is increased oxidative stress in MB leprosy, especially in LL. This warrants antioxidant supplements to prevent tissue injury.

Metabolism of dietary ODAP in humans may be responsible for the low incidence of neurolathyrism

OBJECTIVES

The reasons for the very low incidence of the disease neurolathyrism in humans even after excessive consumption of the pulse, Lathyrus sativus, under severe drought and famine conditions, and its continued consumption by large populations during normal periods without any deleterious effects have been examined in the context of a possible metabolism or detoxification of beta-N-oxalyl-L-alpha, beta-diaminopropionic acid (ODAP), the major neurotoxic amino acid of L. sativus.

DESIGN AND METHODS

ODAP in urine samples from 54 subjects habitually consuming the pulse and in three volunteers on an L. sativus diet was determined by the OPT method following clean up of the samples on an alumina column. Urinary oxalate was also determined in these individuals.

RESULTS

Twenty-five subjects showed no excretion of ODAP and it was only less than 0.7% of the dietary intake in the remaining 29 subjects. Urinary excretion of ODAP in three volunteers was also less than 1% with a peak excretion in the 4-h sample. The 4-h blood sample from one volunteer had a maximum ODAP concentration of 177 microM. The urinary oxalate content in the volunteers was nearly 3-fold higher compared to controls.

CONCLUSIONS

The low excretion of dietary ingested ODAP in humans is in sharp contrast to that seen in animals and indicates a metabolism or detoxification of ODAP which may be unique to humans and may explain the low incidence of neurolathyrism.

Evaluation of teniposide (VM-26)-induced toxicity on mouse spermatogenesis by flow cytometry

Alteration in the testicular weight and various germ cell populations was studied in male mice treated with different doses (0.05, 0.25, 0.5, 1.0 and 2.0 mg/kg b. wt.) of teniposide (VM-26) at various post-treatment time periods. Treatment of mice with different doses of teniposide did not significantly alter the testicular weights, irrespective of the drug dose used. Flow-cytometric analysis of germ cells of the untreated control mice testes revealed four distinct DNA peaks corresponding to elongated spermatids (HC), round spermatids (1C), spermatogonia and non-germ cells (2C) and primary spermatocytes (4C). The region between 2C and 4C peaks represents cells that are actively synthesizing DNA (S-phase cells). Treatment of mice with different doses of teniposide resulted in a significant depletion in the relative percentage of spermatogonia from day 2 to 35 post-treatment depending on the drug dose. DNA-synthesizing, i.e. S-phase, cells declined significantly at day 1 post-treatment and continued to decline up to day 70 post-treatment for all the drug doses studied, except 2 mg/kg drug dose at day 28 post-treatment. A significant decline in the relative percentage of primary spermatocytes (4C) was observed at day 7 that continued up to day 70 post-treatment depending on the drug dose. Round spermatids (1C) declined significantly at day 21 post-treatment after administration of 0.25--2.0 mg/kg VM-26. The relative percentage of elongated spermatids showed a significant decline at day 28 after 1 and 2 mg/kg drug treatment. These alterations in different germ-cell populations are reflected in the various germ-cell ratios. The 4C:2C ratio showed a significant decline at day 7 and 14 post-treatment after 1 and 2 mg/kg VM-26 treatment, while the 1C:2C ratio declined significantly at day 21 post-treatment in the mice treated with 0.5 and 2.0 mg/kg of VM-26. 4C:S-phase and 1C:4C ratios increased significantly from day 1 to 70 post-treatment, depending on the drug dose. Our study demonstrates that the treatment of mice with low doses of VM-26 exerts cytotoxic effects on various germ-cell populations.

Strain-dependent variability in immune response to chicken riboflavin carrier protein in mice with different haplotypes

Active immunization of fertile female mice, rats and sub-human primates with linearized chicken riboflavin carrier protein (RCP) curtailed pregnancy suggesting that sequence-specific RCP antibodies interfere with fertilization/early embryo development. To investigate the genetic basis of variations in immunogenecity, antibody response to reduced and carboxymethylated RCP (RCM-RCP) was studied in different strains of mice of independent H-2 haplotypes. Among these, AKR (H-2k) were low or non-responders. Measurement of antibody titers in hyperimmune sera showed that among responder strains of mice, C57BL/6 (H-2b) and BALB/c (H-2d) generated higher levels of antibody compared to mice of SJLJ (H-2S). The relative affinities of these antibodies also varied depending upon the strain, with BALB/c mice showing highest affinity. Epitope mapping by pepscan ELISA revealed significant variability in determinant-specific antibody populations, with SJLJ strain lacking antibodies to N-terminal half of RCP sequence. However, four immunodominant sequential epitopes (residues 100-107, 134-141, 174-181 and 200-207) common to all the three strains of mice have been identified. Binding to these regions was not haplotype restricted although there were qualitative differences in recognition patterns. Present investigations have shown that site-specific antibodies directed towards any one of the four epitopic regions comprising of residues 3-24, 64-83, 130-147 and 200-219 in chicken RCP sequence effectively interfered with pregnancy establishment in female BALB/c mice. This implies the propensity of RCP antibodies to curtail pregnancy in the other two responder mouse strains also.

In vivo metabolism of beta-N-oxalyl-L-alpha,beta-diaminopropionic acid: the Lathyrus sativus neurotoxin in experimental animals

A comparative study of the metabolism of 1,2,3 (14)C-ODAP and 4,5 (14)C-ODAP in mice, rats and chicks has been carried out. Following oral administration of 1,2,3 (14)C-ODAP to either black or white mice, nearly 16% of the radioactivity appeared in the expired CO2 within 8 h, while in the rat only 3% of it appeared and in chicks it was less than 2%. No 14CO2 appeared in the expired air in mice given 4,5 (14)C-ODAP. Electrophoregrams of the spot urine samples from the animals given 1,2,3 (14)C-ODAP showed the presence of one radioactive metabolite (metabolite-1) in addition to ODAP. While the urine from rats and mice given 4,5 (14)C-ODAP indicated the presence of metabolite-1 as well as 14C-oxalate, in chicks, however, no 14C-oxalate was present and only metabolite-1 could be detected. The results indicate that ODAP can to some extent undergo oxidation in vivo in mice (and to a lesser extent in rats) leading to the formation of CO2 and oxalate and a similar pathway might be more prominent in humans leading to a near complete oxidation of ODAP.

Influence of teniposide (VM-26) on radiation-induced damage to mouse spermatogenesis: a flow cytometric evaluation

The effect of teniposide (VM-26) 0.05 mg/kg body weight treatment on spermatogenesis of mice exposed to 0, 0.5, 1, 2, and 3 Gy gamma-radiation was evaluated flow cytometrically. Whole body irradiation with 1 to 3 Gy resulted in a significant decline in testis weight from Day 14 to 35 post-irradiation depending on the exposure dose. Treatment of mice with teniposide before irradiation advanced the decline in testicular weight by several days, especially at 3 Gy, where a significant decline in testicular weight was observed at Day 7 post-irradiation when compared with the double distilled water (DDW)+irradiation group. The relative percentage of the 2C population declined significantly in the VM-26+irradiation group in comparison with the DDW+irradiation group at various post-irradiation time periods depending on the exposure dose. A significant depletion in the relative percentage of S-phase cells was observed as early as Day 1 post-irradiation in the VM-26+irradiation group when compared with the DDW+irradiation group after exposure to 1 to 3 Gy. This decline continued up to Day 21 post-irradiation after exposure to 2 Gy. The relative percentage of primary spermatocytes showed a consistent decline after exposure to various doses of gamma-radiation in the VM-26+irradiation group when compared with the DDW+irradiation group at different time periods, with a few exceptions, especially at higher doses. The pattern of decline in the relative percentage of round spermatids was similar to that of primary spermatocytes, where a significant decline was observed at various post-irradiation time periods in the VM-26+irradiation group in comparison with the DDW+irradiation group. These changes in the relative germ cell percentages are manifested as alterations in the ratios of various germ cell populations. The 4C:2C ratio declined consistently from Day 1 to Day 70 post-irradiation in the VM-26+irradiation group at all exposure doses. Similarly, the 4C:S-phase ratio in the VM-26+irradiation group also showed a significant decline at different post-irradiation time periods when compared with the DDW+irradiation group depending on the exposure dose. The reduction observed in the relative percentages of various cell populations was higher in the combination group when compared with the DDW+irradiation controls, indicating potentiation of damage to male germ cells by teniposide treatment before irradiation.

Radioprotective effect of zinc aspartate on mouse spermatogenesis: a flow cytometric evaluation

The radioprotective effect of zinc aspartate on spermatogonial cells of whole-body irradiated mice was studied using flow cytometry. Adult male Swiss albino mice were treated with 30 mg/kg body weight of zinc aspartate 30 min before exposure to 0, 0.5, 1, 2 and 3 Gy of gamma-radiation. The animals were killed 7 to 70 days postirradiation and the relative percentages of different germ cells were analyzed by flow cytometry. A significant increase (p<0.002, 0. 0001, 0.005 and 0.008 for 0.5, 1, 2 and 3 Gy, respectively) in the relative percentage of spermatogonial (2C) population was observed in mice treated with zinc aspartate before exposure to different doses of gamma-radiation, compared to the irradiated controls on day 35 posttreatment. Also mean of each radiation dose of all the intervals studied showed a significant (p<0.03) increase in the relative percentage of spermatogonia. Despite the increase in the relative percentage of spermatogonia, the relative percentage of tetraploid cells (4C) remained higher in the zinc aspartate treated mice, compared to the irradiated controls. However, there was no change in the haploid populations viz. round (1C) and elongated (HC) spermatids of the zinc aspartate pretreated animals compared to irradiated controls. These data suggests that zinc aspartate pretreatment protects spermatogonia and tetraploid cells from radiation-induced cell killing.

Effect of vindesine sulfate on the radiation-induced alterations in mouse spermatogenesis: a flow cytometric evaluation

The effect of 0.05 mg/kg body weight of vindesine sulfate was studied on the radiation-induced changes in mouse spermatogenesis at 1, 2, 7, 14, 21, 28, 35 and 70 days post-irradiation. Vindesine administration before exposure to 0, 0.5, 1, 2 and 3 Gy gamma-irradiation resulted in an increase in the radiation-induced perturbations of mouse spermatogenesis at various post-exposure time periods studied. A significant reduction in testicular weight was observed in both DDW + irradiated and VDS + irradiated groups at various post-irradiation time periods, depending on the exposure dose. Vindesine pretreatment resulted in an enhanced killing of spermatogonial cells at day 2 post-exposure at all the exposure doses, except 3 Gy when compared to DDW + irradiated controls. Consequently, the tetraploid (4C) population declined significantly by day 14 post-irradiation followed by a severe depletion in round spermatids (1C) by day 21 post-irradiation. The dose-response relationship for 4C and 1C populations was linear-quadratic at days 14 and 21, respectively. A significant elevation was observed in HC population from days 1 to 21 depending on the exposure dose. The germ cell ratios, viz. 4C:2C, 4C:S-phase, 1C:2C and 1C:4C, showed a significant decline in the VDS + irradiated group when compared to the DDW + irradiated group at various time periods, depending on the exposure dose.

Flow cytometric evaluation of the effect of various doses of vindesine sulphate on mouse spermatogenesis

Spermatogenesis, a rapidly proliferating cell system, is highly susceptible to damage by radiotherapy and/or chemotherapy. Vindesine, a semisynthetic vinca alkaloid, was given as a single injection to adult male Swiss albino mice to study its effects on testicular weight and male germ cell turnover pattern using flow cytometry. Testicular weight declined significantly at Day 7 to 14 and from Day 14 to 35 after administration of 1 and 2 mg/kg b wt vindesine, respectively. Flow cytometric evaluation of various testicular cell types after the administration of 2 mg/kg b wt vindesine revealed a significant increase in the relative percentage of spermatogonial cells at Day 21 and 35 posttreatment. In contrast, the relative percentage of primary spermatocytes declined significantly at Day 7 and 14 posttreatment. Similarly, a significant reduction in the relative percentage of round spermatids was observed from Day 7 to 35 posttreatment. The relative percentage of elongated spermatids declined significantly at day 35 post-treatment. These changes are reflected in the transformation ratios. While the 4C:2C ratio did not exhibit any significant change below 1 mg/kg vindesine, it declined significantly after 1 mg/kg (Day 14) and 2 mg/kg (Day 7 to 35, except Day 28 posttreatment) vindesine treatment. Treatment of male mice with 2 mg/kg vindesine resulted in a significant decline in 1C:2C ratio from 7 to 35 d post-treatment. The 4C:S-phase ratio decreased significantly at Day 7 and 14 posttreatment for all the drug doses above 0.05 mg/kg. A significant reduction in the 1C:4C ratio was observed at day 21 to 35 posttreatment as a result of 2 mg/kg vindesine administration.

Enhancement of micronuclei frequency by vindesine in mouse bone marrow

Treatment of mice with various doses (0, 0.25, 0.5, 1.0 and 2.0 mg/kg b.wt.) of vindesine resulted in a dose-dependent increase in the frequency of micronucleated polychromatic erythrocytes (MPCE) and micronucleated normochromatic erythrocytes. Conversely, the polychromatic erythrocyte and normochromatic erythrocyte (P/N ratio) ratio declined with increasing dose of vindesine. The dose effect relationship for MPCE, MNCE and P/N ratio was linear quadratic.

Evaluation of cytotoxic effects of different doses of vinblastine on mouse spermatogenesis by flow cytometry

The cytotoxic effects of different doses (0 to 8 mg/kg body weight) of vinblastine on mouse spermatogenesis were studied at 7 to 70 days post-treatment. First the gross changes in testicular weight were studied: the doses from 0.05 to 0.5 mg/kg body weight of vinblastine did not show any significant change in testicular weight. However, a dose of 1 mg/kg at day 21 and 28, and 2 mg/kg at all the intervals studied showed a significant decline in testicular weight (P < 0.003 and < 0.03 for 1 and 2 mg/kg, respectively). A further increase in vinblastine dose resulted in a significant decline in testis weight from 7 to 35 days post-treatment. Flow cytometric DNA content measurements were carried out in monocellular suspensions of mouse testis that revealed five quantifiable populations: elongated spermatids (HC), round spermatids (1C), spermatogonia (2C), gonial cells and primary spermatocytes synthesizing DNA (S-phase), and primary spermatocytes (4C) in the control animals. Administration of vinblastine resulted in significant changes in the relative percentages of different germ cell populations as a consequence of which the complete germ cell transformation ratio (HC:2C) declined significantly (P < 0.04) at 21 and 35 days post-treatment (1 and 2 mg/kg). The HC:2C ratio is further divided into 4C:2C, 1C:4C and 1C:2C ratios. The 4C:2C ratio (transformation of spermatogonia to primary spermatocyte) significantly declined at all the post-treatment intervals for 1 and 2 mg/kg vinblastine (P < 0.01). A significant decline in 1C:4C ratio (meiotic transformation) was observed at all the intervals for 0.5 mg/kg (P < 0.004, 0.05, 0.001 and 0.0002 at 7, 14, 21, 28 and 35 days, respectively). This decline in 1C:4C ratio continued at higher doses, i.e. 1 mg/kg (P < 0.0001) and 2 mg/kg (P < 0.0001, 0.005 and 0.0001, respectively) at 14, 21 and 28 days post-treatment. The 1C:2C ratio (spermatocytogenesis) decreased significantly for all the doses by day 14 and 35, except for 0.01 mg/kg (P < 0.04 to 0.0001). Our data suggest that doses of 0.5 mg/kg vinblastine were already cytotoxic to various germ cell populations.