Fecal Microbiota Transplantation for Clostridium difficile-associated Diarrhea in Hematopoietic Stem Cell Transplant Recipients: A Single-center Experience from a Tertiary Center in India

Objectives

Fecal microbiota transplantation (FMT) is an emerging option for recurrent or refractory Clostridium difficile-associated diarrhea (CDAD). We describe a single-center experience of FMT in hematopoietic stem cell transplant (HSCT) recipients with CDAD in India.

Methods

A prospective observational study of HSCT recipients with CDAD who received FMT in our center.

Results

A total of 13 patients were included. All the patients were allogenic HSCT recipients; FMT was performed in seven patients due to refractory CDAD, in five patients due to the presence of both CDAD and graft vs host disease (GVHD), and in 1 patient due to recurrent CDAD. The approach to FMT was colonoscopic in 10 (77%) patients. Only one patient reported bacteremia and one patient had candidemia, both of which were unrelated to FMT. Of the 10 patients who had complete resolution of CDAD, only one patient presented with a recurrence of CDAD within 8 weeks post-FMT.

Conclusion

This is the first study from India using FMT as a therapeutic modality for CDAD in the setting of HSCT. Here we demonstrate that FMT in India is an effective option, especially when patients have refractory CDAD, recurrent CDAD, or both GVHD and CDAD. Further studies should explore the efficacy and feasibility of FMT in India.

How to cite this article

Prayag PS, Patwardhan SA, Ajapuje PS, Melinkeri S, Gadhikar H, Palnitkar S, et al. Fecal Microbiota Transplantation for Clostridium difficile-associated Diarrhea in Hematopoietic Stem Cell Transplant Recipients: A Single-center Experience from a Tertiary Center in India. Indian J Crit Care Med 2024;28(2):106-110.

Transcriptomic comparison of primary bovine horn core carcinoma culture and parental tissue at early stage

Aim:

Squamous cell carcinoma or SCC of horn in bovines (bovine horn core carcinoma) frequently observed in Bos indicus affecting almost 1% of cattle population. Freshly isolated primary epithelial cells may be closely related to the malignant epithelial cells of the tumor. Comparison of gene expression in between horn’s SCC tissue and its early passage primary culture using next generation sequencing was the aim of this study.

Materials and Methods:

Whole transcriptome sequencing of horn’s SCC tissue and its early passage cells using Ion Torrent PGM were done. Comparative expression and analysis of different genes and pathways related to cancer and biological processes associated with malignancy, proliferating capacity, differentiation, apoptosis, senescence, adhesion, cohesion, migration, invasion, angiogenesis, and metabolic pathways were identified.

Results:

Up-regulated genes in SCC of horn’s early passage cells were involved in transporter activity, catalytic activity, nucleic acid binding transcription factor activity, biogenesis, cellular processes, biological regulation and localization and the down-regulated genes mainly were involved in focal adhesion, extracellular matrix receptor interaction and spliceosome activity.

Conclusion:

The experiment revealed similar transcriptomic nature of horn’s SCC tissue and its early passage cells.

Gustatory receptors in Lepidoptera: chemosensation and beyond

Lepidoptera is one of the most widespread insect orders and includes several agriculturally important insect species. Ecological success of the lepidopteran insects partly depends on their adaptive chemoreception tactics, which play an important role in the selection of hosts, egg-laying sites and mates. Members of the G-protein coupled receptor family, gustatory receptors (GRs), are an integral part of the Lepidoptera chemosensory machinery. They are expressed in chemosensory neurones and are known to detect different environmental stimuli. Here, we discuss various aspects of the lepidopteran GRs with an emphasis on their roles in different processes such as chemosensation, host selection and adaptation. Phylogenetic analyses have shown that the large diversity of GR genes may have been generated through gene duplication and positive selection events, which also show lineage- and tissue-specific expression. Moreover, lepidopteran GR proteins are diverse and demonstrate broad ligand selectivity for several molecules including sugars, deterrents, salts and CO2 . Binding of ligands to GRs generates multiple downstream changes at the cellular level, which are followed by changes in behaviour. GRs play a critical role in chemosensation and influence the insect's behaviour. Overall, insect GRs are potential targets in the design of effective insect control strategies.

Study on inclusion of probiotic, prebiotic and its combination in broiler diet and their effect on carcass characteristics and economics of commercial broilers

Background and Aim:

In today era, broiler industry facing a problem of price hiking of feed of broiler, also in competitive era there should be lower feed cost, lower feed conversion ratio, low feed consumption yet good body weight at marketable age.

Materials and Methods:

Day-old commercial broiler chicks (n=200) were distributed randomly into 5 dietary treatment groups viz. control (T₁), probiotic in the feed @ 100 g/tonne of feed (T₂), prebiotic in the feed @ 500 g/tonne of feed (T₃), probiotic + prebiotic @ 100 g/tonne and 500 g/tonne of feed, respectively (T₄) and probiotic + prebiotic @ 50 g/tonne and 250 g/tonne of feed (T₅). The growth of broilers and dressing weight along with the weight of giblet (liver without gall bladder, gizzard without serous layer, and heart without pericardium), Kidney, Abdominal fat, Length of Intestine and dressing percentage were measured. Economics in terms of Return Over Feed Cost (ROFC) and European Performance Efficiency Index (EPEI) was calculated.

Results:

Among all carcass traits, dressing percentage, abdominal fat weight and abdominal fat percentage (as a percentage of dressed weight) were recorded significant (p<0.05) difference among different treatment groups. The income from selling of the birds was significantly (p<0.05) higher in all treatment groups than the control group but there was a non-significant difference between supplemented groups. Feed cost during whole experimental period was significantly (p<0.05) lower in synbiotic supplemented groups (T₄ and T₅) than other groups. ROFC of all treatment group found significantly (p<0.05) higher than the control group.

Conclusion:

It can be concluded that the diet supplemented with synbiotic (100% level) was most efficient in terms of EPEI and synbiotic (50% level) in terms of ROFC. Hence, as feed supplement, synbiotic has a beneficial effect over probiotic and prebiotic when used alone.

Way toward "dietary pesticides": molecular investigation of insecticidal action of caffeic acid against Helicoverpa armigera

Bioprospecting of natural molecules is essential to overcome serious environmental issues and pesticide resistance in insects. Here we are reporting insights into insecticidal activity of a plant natural phenol. In silico and in vitro screening of multiple molecules supported by in vivo validations suggested that caffeic acid (CA) is a potent inhibitor of Helicoverpa armigera gut proteases. Protease activity and gene expression were altered in CA-fed larvae. The structure-activity relationship of CA highlighted that all the functional groups are crucial for inhibition of protease activity. Biophysical studies and molecular dynamic simulations revealed that sequential binding of multiple CA molecules induces conformational changes in the protease(s) and thus lead to a significant decline in their activity. CA treatment significantly inhibits the insect's detoxification enzymes, thus intensifying the insecticidal effect. Our findings suggest that CA can be implicated as a potent insecticidal molecule and explored for the development of effective dietary pesticides.

Sub-conjunctival dislocation of posterior chamber intra-ocular lens: five years after manual, small-incision cataract surgery

INTRODUCTION

Ocular trauma can cause serious complications in eyes operated for cataract.

CASE

A 70-year- old lady had sustained blunt trauma to the left lower lid which resulted in a sub-conjunctival dislocation of the posterior chamber intraocular lens (PCIOL). The patient had undergone an uneventful manual, small-incision, sutureless cataract surgery with implantation of a PCIOL for senile cataract five years ago in the same eye. She had no ocular or systemic predisposing factors for wound dehiscence. Surgical exploration revealed a scleral rupture 7 mm in length, 2 mm behind the limbus at the 12'O clock position along the surgically-constructed wound. However, the scleral tunnel was not damaged. The PCIOL was removed. Wound closure was done to avoid infection of the intraocular structures. Her best-corrected visual acuity was 20/60 at the three months' follow-up.

CONCLUSION

Surgeons should be aware of such complications occurring due to trauma. We recommend suturing of the scleral wound to strengthen it in cases of a deep scleral groove or when there is a possibility of a premature entry of the wound into the anterior chamber.

Differential protease activity augments polyphagy in Helicoverpa armigera

Helicoverpa armigera (Lepidoptera: Noctuidae) and other polyphagous agricultural pests are extending their plant host range and emerging as serious agents in restraining crop productivity. Dynamic regulation, coupled with a diversity of digestive and detoxifying enzymes, play a crucial role in the adaptation of polyphagous insects. To investigate the functional intricacy of serine proteases in the development and polyphagy of H. armigera, we profiled the expression of eight trypsin-like and four chymotrypsin-like phylogenetically diverse mRNAs from different life stages of H. armigera reared on nutritionally distinct host plants. These analyses revealed diet- and stage-specific protease expression patterns. The trypsins expressed showed structural variations, which might result in differential substrate specificity and interaction with inhibitors. Protease profiles in the presence of inhibitors and their mass spectrometric analyses revealed insight into their differential activity. These findings emphasize the differential expression of serine proteases and their consequences for digestive physiology in promoting polyphagy in H. armigera.

Follicular mucinosis in suspected leprosy

Four cases of suspected leprosy showed, on biopsy, follicular mucinosis without any granulomatous inflammation. All the patients were adolescents (12-17 years) with a single lesion on the face. Three patients showed complete clearing after anti-leprosy treatment, and the fourth patient is currently taking anti-leprosy treatment and showed good clinical response.

Disseminate and persistent infundibulo-folliculitis

An 18-year-old girl presented with a persistent skin eruption of 6 years duration. She had skin-coloured follicular papules involving the trunk, proximal extremities, neck and face. Histopathology revealed spongiosis of the follicular infundibulum and infiltration with lymphocytes and neutrophils. Treatment with oral vitamin A and topical retinoic acid was ineffective.

Comparison of topical methenamine, glutaraldehyde and tap water Iontophoresis for palmoplantar hyperhidrosis

Sixty patients with palmo-plantar hyperhidrosis were studied to compare the efficacy and safety of topical methenamine in the treatment of palmo-plantar hyperhidrosis with established therapies like glutaraldehyde and tap water iontophoresis. Patients were randomly allocated to 3 treatment groups: topical Methenamine (10%) solution, topical Glutaraldehyde (5% for palms and 10% for soles) and tap water iontophoresis. Hyperhidrosis was graded into 4 grades. The total duration of therapy was 4 weeks for all the 3 groups. Patients were followed up weekly for 4 weeks and 2 weeks after completion of therapy. Response to therapy was evaluated by the change in the grade of hyperhidrosis. Side-effects like irritation and pigmentation were looked for at every follow up. Wilcoxon's rank sum test was used for comparison between changes in grading of 2 groups. It showed that methenamine is superior to tap water iontophoresis and acts faster than glutaraldehyde. Fewer side effects were noted with mether amine.

Effects of MK-801, a non-competitive NMDA antagonist, on linguopharyngeal events in rats

The effects of MK-801 at doses from 0.005 to 1 mg/kg IP on linguopharyngeal events (protrusions, retrusions and swallows) were determined in rats to find out whether MK-801 resembles ketamine in its capacity to increase the frequency of recurrence of such events that we have demonstrated in previous studies. All rats receiving a dose of 0.05 mg/kg or higher showed an increase in linguopharyngeal event frequency within 5 min and this enhancement (3-fold from baseline level) was maintained for longer than 1 h. At the lowest dose of 5 micrograms/kg the effect lasted only very briefly. A general increase in motor behavior was also observed within 10 min of drug administration. More complex patterns of motor behavior, consisting of stereotypical head bobbing, paw movements reminiscent of walking activity, nystagmus, and ataxia were observed with doses of 0.25 mg/kg and higher. All rats showed a marked startle response at early stages post-injection and hypersensitivity to external stimuli such as noise or movement in the room. However, there was an absolute lack of coordinated avoidance responses normally associated with such startle responses or arousing stimuli.

Unitary correlates of linguo-pharyngeal events in a dyskinetic rat model

1. The hypoglossal nucleus unitary correlates of ketamine- and electrically induced tongue contractions and swallowing events were recorded and compared in stereotaxically mounted rats. 2. Very few of the units recorded could be identified as motoneurons by antidromic invasion through electrical stimulation of the hypoglossal nerve. 3. The sample consists of 109 units, 2/3 of which were located in the retrusor pool and 1/3 in the protrusor region. 4. Linguo-pharyngeal events were considered to be electrically induced if they followed consistently, and with a relatively fixed latency, a single electrical pulse delivered to the superior laryngeal nerve, and ketamine-induced if no such time-locked sequence existed or if they occurred in the absence of electrical stimulation. 5. No differences could be discovered between the two types of linguo-pharyngeal events whether they were compared at the polygraphic or the unitary level. 6. These findings suggest that pharmacologically (ketamine)-induced dyskinetic activity does not differ from comparable motor patterns induced by classical electrophysiological means.

Strain-Specific Inhibition of nod Gene Induction in Bradyrhizobium japonicum by Flavonoid Compounds

A broad-host-range plasmid, pEA2-21, containing a Bradyrhizobium japonicum nodABC'-'lacZ translational fusion was used to identify strain-specific inhibitors of the genes required for soybean nodulation, the common nod genes. The responses of type strains of B. japonicum serogroups USDA 110, USDA 123, USDA 127, USDA 129, USDA 122, and USDA 138 to nod gene inhibitors were compared. Few compounds inhibited nod gene expression in B. japonicum USDA 110. In contrast, nod gene expression in strains belonging to several other serogroups was inhibited by most of the flavonoids tested. However, the application of two of these strain-specific compounds, chrysin and naringenin, had little effect on the pattern of competition between indigenous and inoculum strains of B. japonicum in greenhouse and field trials. Preliminary studies with radiolabeled chrysin and naringenin suggest that the different responses to nod gene inhibitors may be partly due to the degree to which plant flavonoids can be metabolized by each strain.

Effects of clozapine on ketamine-induced linguopharyngeal events in rats

We tested the effects of clozapine (0.02-20 mg/kg i.p.) on ketamine-induced linguopharyngeal events in rats anesthetized with i.m. injections of ketamine hydrochloride (100 mg/kg) and mounted on a stereotaxic with the tip of the tongue tied to a force displacement transducer monitoring tongue protrusions, retrusions and swallows. Reduction began at the 0.04 mg/kg dose. At 4.8 mg/kg there was total suppression of events. At 20 mg/kg, suppression lasted for 1 h. Notably clozapine doses causing total suppression of events in our model were much lower than those usually reported to alter dopamine turnover.

Metoclopramide fails to suppress linguopharyngeal events in a rat dyskinesia model

The effects of metoclopramide on ketamine-induced linguopharyngeal events exemplified by tongue retrusions, protrusions, and swallowing acts were tested in ketamine-anesthetized rats mounted on a stereotaxic frame with the tip of the tongue tied to a force displacement transducer to monitor retrusion and protrusion and a pressure transducer inserted into the mouth at the level of the soft palate to monitor swallowing. Metoclopramide at doses ranging from 0.5 to 50 mg/kg im failed to decrease protrusions, retrusions, or swallowing. It rather increased all three events for up to 2.5 hours. The significance of these findings is discussed.

Effects of cholinergic and anticholinergic drugs on ketamine-induced linguopharyngeal motor activity

Benztropine mesylate (Cogentin) and physostigmine salicylate (Antilirium), were tested for changes in tongue protrusions, retrusions, and swallowing acts in rats anesthetized with a 100 mg/kg IM injection of ketamine hydrochloride. These ketamine-induced linguopharyngeal events were monitored by means of a force displacement transducer fed onto a polygraph. Benztropine (0.05-1 mg/kg) caused mild to moderate reductions in the rate of these events for a short period of time, up to about 30 min. With physostigmine (5-25 micrograms/kg), linguopharyngeal activity was markedly increased, up to 50-fold by the highest dose within 5 min and returned almost to the baseline within 60 min. With lower doses, more moderate responses were obtained. If methscopolamine (1.4, 3, 6 mg/kg IM) preceded physostigmine, the physostigmine enhancement was preserved.