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   2019| July-September  | Volume 3 | Issue 3  
    Online since September 11, 2019

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Insight to foodborne diseases: Proposed models for infections and intoxications
Rashed Noor
July-September 2019, 3(3):135-139
Disclosure of microbial prevalence in different food items around the globe is very much likely due to the pathogenic microbial propagation, as well as due to lack of sufficient understanding on food poisoning mechanism. A line of microbiological analyses of foods unstitched the promulgation of Escherichia coli and their toxins, Staphylococcus spp., Vibrio spp., Aeromonas spp., and Listeria spp. While the cases of food poisoning are handled frequently basically with the treatment strategies, the inner mechanism of the food poisoning by microorganisms remains unraveled. In the present review, author attempted to formulate models for the foodborne infections, intoxications, and toxicoinfections. Understanding of these models and pathogenesis would be useful to combat foodborne diseases using the accurate strategies to resolve the complications and to improve the public health as well.
  6,912 482 -
Antibiotic susceptibility profile of uropathogens in rural population of Himachal Pradesh, India: Where We are heading?
Priya Mehrishi, Sameer Singh Faujdar, Satish Kumar, Seema Solanki, Amisha Sharma
July-September 2019, 3(3):171-175
Background: Urinary tract infection (UTI) is one of the most common infectious diseases at the community level. To assess the adequacy of the empirical therapy, the prevalence and the resistance pattern of the main bacteria responsible for UTI in the rural community of Himachal Pradesh (HP) was evaluated. Methods: In this retrospective study, all urine samples from patients of the District of Solan, in HP, collected at the Department of Microbiology, Maharishi Markandeshwar Medical College and Hospital during 2014–15 were analyzed. Samples with more than 105 CFU/mL bacteria were considered positive, and for these samples, the bacteria were identified, and the profile of antibiotic susceptibility was characterized. Results: A retrospective analysis of 1878 urine samples over 2-year period at a teaching hospital was carried out according to the standard protocol of urinalysis. The results were processed to obtain the profile prevalence of UTI, the rate of bacterial resistance to antibiotics, the trend of their evolution over time, and the rate of multidrug resistance. Conclusion: Escherichia coli was the most common uropathogen. Amikacin and piperacillin/tazobactam were the most effective antibiotics against uropathogens.
  2,650 299 -
High risk disease mapping and spatial effect of pulmonary tuberculosis in Kerbala, Iraq
Suhad Hadi Mohammed, Mohanad Mohsin Ahmed, Zuhair Hasan Mohammed, Azeez Adeboye
July-September 2019, 3(3):150-155
Introduction: Pulmonary tuberculosis (PTB) remains one of the top ten causes of death globally. A crucial component of controlling this infection is by limiting the spread of the disease. This study aimed to identify hot spot geographical areas with PTB incidence and to evaluate spatial global autocorrelation using geographical information science (GIS) technology. Methods: Using tuberculosis register software, cases of PTB were recorded by Chest and Respiratory illnesses center in Kerbala governorate. Seven years' data records were used to investigate hot spots and spatial distribution of PTB cases in Kerbala. Patients whom reside outside Kerbala were excluded from the current analysis. Loess smoothing Seasonal decomposition trend was applied to analyze temporal patterns and clusters mapping of tuberculosis, using R statistical software version 3.5.1. Correlation analysis (pairwise Spearman) was used to observe the association among the factors contributing to PTB prevalence. Standard morbidity ratio (SMRs) was used to find the morbidity rate Bayesian conditional auto-regressive model was used in the analysis and estimation of the parameters was done through Markov Chain Monte Carlo methods to estimate the space mapping variability cluster of disease risk and covariates effect. Results: A significant correlation was found between PTB prevalence and the age (r = 0.731) and was also found in gender (r = 0.822). Most of the cases were distributed within the age of 17–50 years (68.4%). Tuberculosis cases were not randomly distributed in which the variables occur with asymptotic probabilities with unpredictable spacing and that there was the presence of high global autocorrelation among PTB cases in the City of Kerbala. Approximately, 59% of all PTB cases were seen in six quarters. Conclusion: Spatial analysis using GIS reveals useful information about epidemiological situation of PTB cases in Kerbala Province, Iraq. Additionally, this study predicted possible places for PTB transmission based on hot spot analysis and the continuous presence of infection during the studied period.
  2,708 234 -
Molecular docking studies of filarial β-tubulin protein models with antifilarial phytochemicals
Sumit T Halder, Tehseen M Dhorajiwala, Lalit R Samant
July-September 2019, 3(3):162-170
Background: Lymphatic filariasis affects millions of people worldwide, majorily people from lower socioeconomic strata, who cannot afford proper medication and seek local treatments, mostly involving the application or administration of plant extracts. Lymphatic filariasis is caused by filarial worms, and it has been reported that tubulin beta chain protein of these worms serves as an important drug target to inhibit their growth and development. This study aims to find phytochemicals which can be used as natural inhibitors of filarial worms by targeting tubulin beta chain protein present in them. Methods: Protein structure homology modeling was carried out to model the target protein of lymphatic filariasis-causing organisms. A total of 105 phytochemicals were screened for their absorption, distribution, metabolism, excretion, and toxicity (ADMET) properties, and 12 phytochemicals which passed all the filters were used for comparative docking studies along with drug albendazole which is proved to bind to tubulin beta chain of roundworms. In silico molecular docking was performed using AutoDock Vina, and several phytochemicals were found to have better binding affinity than albendazole. Results: Based on binding affinity and ADMET properties, hecogenin was selected as the best lead molecule. SwissDock was used to confirm hecogenin which has better binding affinity than albendazole against target proteins. Conclusion: This study suggests that hecogenin and other potent phytochemicals such as (-)-epicatechin, akuammicine, apigenin, boeravinone A, boeravinone B, catechin, diosgenin, rhein, and ruscogenin have promising antifilarial properties and can be used as natural inhibitors of tubulin beta chain of lymphatic filariasis-causing organisms.
  2,642 270 -
Evaluation of the therapeutic, diagnostic, and prognostic means currently applied to counter the surge of tuberculosis
Roland Maes
July-September 2019, 3(3):140-146
The bacilloscopy and culture, the skin test, the BCG vaccine and the discovery of five powerful anti-TB chemicals were assumed sufficient to win the war on TB after World War II but the enigmas and paradoxes uncovered during treatment were given no heed and the humoral immune capacities of the patient were totally ignored. TB resurged at the turn of the century, with a vengeance. The patient suffering from a TB infection mounts a humoral immune response that is as important as a cellular immune reactivity and is useful as a prognostic of treatment outcome and as a diagnostic of latent infections. The anti-TB chemicals are expensive, highly toxic and some destroy the immunocytes of the patient. Their use may provoke a drastic plunge of antibodies' production, which leaves the patient deprived of immunological resources and exposes the successfully treated patient to relapse. The monitoring of the IgG class of anti-TB antibodies synthetized by a subject suffering from a latent infection prone to convert allows the detection of these cases. At the onset of diagnosed cases, the level of these antibodies is sometimes very low, indicating an immunodepression generated by the pathogen. The monitoring of the rise of their production during treatment permits a control of the efficacy of the treatment. A food supplement consisting of RNA oligonucleotides is available, whose property is to stimulate the multiplication of leucocytes and platelets.
  2,661 202 -
Specific IL-5 snp is associated with high serum IL-5 levels and higher eosinophil counts among iraqi asthmatic children
Raghdah Maytham Hameed, Mohanad Mohsin Ahmed, Haidar Abdul Amir Najim Abood
July-September 2019, 3(3):156-161
Objective: Interleukin-5 (IL-5) is a cytokine known to play major role in the regulation of eosinophil formation, maturation, recruitment, and survival. Hence, an increased production of IL-5 may be contributed to the pathogenesis of eosinophil-dependent inflammatory diseases such as asthma. Methods: A total of 85 children, including 59 males and 26 females with asthma with ages between 1 year and 16 years, attended the Respiratory Clinic at Karbala pediatric hospital, with a nonasthmatic children group which have the same age and gender. Restriction fragment length polymerase chain reaction was performed to determine IL-5 C-703T genetic polymorphisms. Total immunoglobulin E (IgE) level was measured using the EUROIMMUN IgE ELISA kit and serum IL-5 levels using Elabscience ELISA kit. The absolute eosinophil count was measured by five differential automated hematology analyzers and confirmed by the examination of peripheral blood smear. Results: The TT genotype of IL-5 C-703T polymorphism was associated with asthmatic children (P: 0.033). In addition, TT genotype was associated with increase of serum IL-5 levels and high absolute eosinophil count (P = 0.008 and 0.021, respectively). Whereas, CT genotype of IL-5 C-703T was found to be associated with high total serum IgE (P < 0.001). Conclusions: Asthma in children is associated with IL-5 C-703T polymorphism. In addition, IL-5 C-703T polymorphism has impact on IL-5 levels and eosinophil count. TT genotype of IL-5 C703T consider a risk factor for mild asthma in Iraqi asthmatic children.
  2,453 220 -
Management of ankyloglossia
Aishwarya Madhukar Kale, Kunal Sunder Sethi, Prerna Ashok Karde, Alefiya Shabbir Mamajiwala
July-September 2019, 3(3):206-209
Tongue-tie which is also known as ankyloglossia originated from the Greek word “agkilos” which means curved and glossa which means tongue. Ankyloglossia is usually associated with difficulty in speech articulation and breastfeeding as it causes limited tongue movement. There are different modalities available to manage ankyloglossia. A 23-year-old male with ankyloglossia and a chief complaint of difficulty with speech underwent lingual frenectomy under local anesthesia using a standard surgical technique using scalpel and blade that was followed with speech therapy. One-month follow-up showed marked improvement in tongue movements with no signs of recurrence. Early diagnosis and proper surgical intervention are key to help the patient to avoid problems associated with ankyloglossia and lead a better life.
  2,234 181 -
Validation and impact of the use of automated urine culture streak system in a diagnostic laboratory on surveillance of catheter-associated urinary tract infections at a tertiary care setting
Mohammad Zeeshan, Joveria Farooqi, Saeeda Chandio, Zohra Rafiq, Rozina Roshan, Seema Irfan
July-September 2019, 3(3):202-205
Background: Quantitative urine culture reporting on plates inoculated by automated streaking system (PREVI® Isola) demonstrates maximum growth only equivalent up to 104 colony-forming unit (CFU)\ml, according to the manufacturer's recommendation. Therefore, there is a probability of erroneous catheter-associated urinary tract infection (CAUTI) surveillance data as a count of ≥105 CFU/ml is required according to CAUTI definition. This study aimed to validate automated urine culture streak system for improving the surveillance of hospital-acquired CAUTIs. Materials and Methods: This was a prospective, cross-sectional study. In 1-month duration, urine samples of 1000 consecutive patients reported to the microbiology section for culture and sensitivity were included. Samples were processed simultaneously manually (1 μl loop) and with an automated streaking system. Plates streaked by automated method were arbitrarily divided into eight equally sized segments. After 24 h of incubation at similar conditions, microbial growths in each segment were noted and correlated with its manual colony count. To minimize the error, colony count and morphotype were analyzed by a senior technologist and counterchecked by a consultant. Results were recorded on an Excel sheet. Results: Growth on the 7th and 8th segments corresponded with ≥105 CFU/ml. Growth up to the 4th, 5th, and 6th segments corresponded with 104 CFU/ml, whereas the 3rd segment with >103 but <104 CFU/ml. Any growth in the 1st and 2nd sectors was considered insignificant. Conclusion: Quantitative urine culture analysis inoculated by automated streak system corresponds to the CAUTI surveillance definition. Colony count requires validation with manual method before implementing in laboratory.
  2,048 157 -
Drug-resistant tuberculosis and cross-border patient: A retrospective analysis from a Thailand–Myanmar border area
Pathum Sookaromdee, Viroj Wiwanitkit
July-September 2019, 3(3):147-149
Background: Drug-resistant tuberculosis becomes an important clinical problem in clinical mycobacteriology. The high incidence of drug-resistant tuberculosis is presently reported from Indochina, a tropical zone of the world. Methods: This work is a retrospective study on the available epidemiological data regarding drug-resistant tuberculosis in a Thailand–Myanmar border area. Results: The change of incidence of tuberculosis and drug-resistant tuberculosis can be demonstrated. The cross-border patient contributes to an important proportion of overall cases with tuberculosis and drug-resistant tuberculosis in this setting. Conclusion: Cross-border patient can affect the local situation of drug-resistant tuberculosis. To have a specific action regarding tuberculosis control for the cross-border patient is very important.
  1,960 184 -
In vivo antimalarial activity, toxicity, and phytochemical composition of total extracts from securidaca longepedunculata Fresen. (polygalaceae)
Joseph Mwanzia Nguta
July-September 2019, 3(3):196-201
Introduction: Alternative antimalarial drugs are urgently required. Securidaca longepedunculata Fresen. (Polygalaceae) is a medicinal plant with a long history of use in African ethnomedicine to treat malaria and other illnesses. The efficacy, safety, and chemical composition of chloroform: methanol (1:1) and aqueous total extracts from the leaves, stem, and roots of S. longepedunculata were investigated. Methods: Adult Swiss female mice were infected with 107 erythrocytes parasitized with Plasmodium berghei (strain ANKA) on day 0 as a model of malaria. Effects of crude extracts at a dosage rate of 100 mg/kg of body weight on parasitemia were measured over a 4-day period. To evaluate acute toxicity, the mice were administered crude extracts by oral gavage at 50, 300, and 2000 mg/kg of body weight and observed over a 24-h period. Cytotoxic effects of crude extracts were measured using human epithelial-2 cells in a 96-well microtiter plate over a 24-h period. Results: Chloroform: methanol (1:1) and aqueous root extracts demonstrated significant chemosuppressive activities of 91.46% and 87.64%, respectively (P < 0.05). CC50values ranged from 115 to 140 μg/mL and an LD50>2000 mg/kg body weight. Crude extracts contained alkaloids, anthraquinones, flavonoids, saponins, steroids, tannins, and triterpenoids. Conclusion: The findings from the current study validate ethnopharmacological use of the plant, while demonstrating its potential as a possible source of new lead molecules against malaria.
  1,631 240 -
Evaluation of epidemiological and clinical features of patients with pneumococcal and legionella pneumonia
Tina Rabooki, Seyed Hamid Hashemi, Diana Rabooki, Hamidreza Ghasemibasir, Manochehr Karami
July-September 2019, 3(3):176-181
Background: Pneumonia is one of the major causes of morbidity, mortality, and hospitalization. It is developed by a variety of organisms including Streptococcus pneumoniae and Legionella spp. In this study, the epidemiological and clinical characteristics of patients with Legionella pneumonia (Legionnaires' disease) and pneumococcal pneumonia were compared. Methods: In this crosssectional study, all patients with pneumonia who were hospitalized in Sina Hospital, Hamedan, Iran, were identified. Using blood, sputum, and urine cultures, the patients infected by Streptococcus pneumonia and Legionella pneumonia were isolated. The two groups were compared in terms of the age, sex, clinical signs, risk factors, severity of the disease (using the CURB65 score), and the outcome of the disease. Data were analyzed using SPSS software at 95% confidence level. Results: A total of 30 patients including 17 (56.67%) patients with pneumococcal pneumonia and 13 (43.33%) patients with Legionella pneumonia were included in the study. In the patients with pneumococcal and Legionella pneumonia, the mean and standard deviation of the age were 58.38 ± 20.92 and 56.76 ± 22.49 years, respectively. 23.50% of the patients with pneumococcal pneumonia and 38.50% of the patients with Legionella pneumonia were male (P = 0.376). No statistically significant differences were found between patients with pneumococcal and Legionella pneumonia in terms of clinical symptoms, risk factors, severity of pneumonia based on the CURB65 score, and treatment outcome (P > 0.05). Conclusions: Age and sex distributions of the patients with Legionella and pneumococcal pneumonia were not significantly different. The patients in the two groups were not significantly different in terms of risk factors, clinical symptoms, and disease outcome.
  1,652 143 -
Detection of genetic mutations in inh A and kat G for isoniazid and its association with rifampicin resistance in tuberculosis confirmed by line probe assay: Its rationality for isoniazid prophylaxis empirical or drug susceptibility testing guided
Prasanta Kumar Das, Somtirtha B Ganguly, Bodhisatya Mandal
July-September 2019, 3(3):182-188
Background: The preventive treatment of tuberculosis (TB) is practiced worldwide to execute effective control on its spread. The need for a streamlined definitely structured guideline is realized worldwide. Although there are several guidelines, proper rationale to the use of antibiotics as an effective prophylaxis is yet an area to be discussed. The practice of using an anti-tubercular drug without seeing the resistance pattern and its rationality as a prophylaxis is at the question. Involvement of inhA and kat G in conferring isoniazid (INH) resistance among the rifampicin (RMP) resistant as well as sensitive cases were observed and compared to find out any correlation between resistance of INH and RMP. Moreover, the treatment of drug-resistant TB with the second line of anti-tubercular drugs has been a difficult affair. The revised national TB program advocates INH prophylaxis to the pediatric population who are at an augmented risk of getting the infection from close contacts, without knowing the resistant pattern of the strain of contacts. The study projects the inhA and kat G status among the RMP-resistant adult and pediatric cases. The genetic patterns of INH resistance and their different mutations among isolates of the cases obtained from the adult and pediatric age group of RMP resistance are taken under the study. The point and periodic prevalence is worked out and considered in terms of evaluating the prophylaxis among the probable contacts of the source cases. The guidelines of managing of contacts of multidrug-resistant (MDR) TB and extensively drug-resistant TB patients have little scientific evidence to support and there is lack of national guidelines owing to the discrepancies as is strongly felt.[1] Pediatric contact groups are likely to have latent TB infection (LTBI) that might follow an active TB disease development. Contacts of MDR-TB are considered as LTBI cases. These cases are subjected to preventive therapy.[2] Most of the public health program follows the WHO guideline advocating the use of INH as a prophylaxis irrespective of the resistant status of the source strain. Various national programs advocated administering of a conventional drug as a preventive therapy without actually knowing the susceptibility pattern of the infecting strain of the source case.[3] The selection of a preventive regimen with single or multiple drugs ideally to be based on considering the availability and the bactericidal activity of the primarily infecting strain. Drug-resistant TB among the new and retreatment cases was about 5% in accordance to the surveillance done.[4] The overall proportion of MDR-TB, defined as TB resistant to at least INH and RMP, with or without resistance to other first-line drugs, was 5.3%, ranging from 0% to 35% of reported TB cases.[4] The percentage among the retreatment cases showed a steady rise over the years. The retreatment cases contributed about 20% of MDR-TB among the high TB burden nation.[4] In 2009, only 30,000 (7%) of the 440,000 estimated MDR-TB cases globally were notified, and of them, only 11,000 (3%) were put on treatment known to be consistent with international guidelines.[5] A systematic analysis of the nature of the resistance conferred toward INH may contribute in understanding the common as well as rare genetic alterations. INH resistance is classified as high and low-level resistance based on the minimum inhibitory concentrations. It has been found that the high- and low-level resistance toward INH is associated with the kat G and inh A genes, respectively. Treatment protocols are availed in accordance. The INH resistance is determined in all tubercular cases adult and pediatric irrespective of RMP resistance status, it is found that 92.7% are INH resistant by kat G among RMP-resistant cases. Whereas 17.8% of INH resistance by katG are even among RMP sensitive cases. This relates to a community threat even more after the implication of INH prophylaxis as a part of national program supported by the WHO, and a challenging threat of rising trend of INH resistance is apprehended. Study Design: The study was undertaken at the Intermediate reference laboratory under state TB demonstration cum training center Kolkata, India under revised national TB control program, from April 2012 to December 2016. The study was done among the 442 RMP-resistant isolates recovered from retreatment cases in the year 2012 as well as 627 from newly diagnosed RMP sensitive cases from 2013 to 2016 the study involves a probe into the point and periodic prevalence of INH among the RMP resistant as well as sensitive cases, the most common and rare patterns of genetic mutation that has led to the INH resistance due to inh A as well as kat G among the RMP resistant and sensitive cases. The common and rare codons along with their change in amino acid sequences involved in conferring the resistance were looked for. Methods: The detection of the patterns of genetic mutation is done by the Genotype MTBDR plus V2 kits.(Hains Life Sciences) based on DNA strip technology (Line Probe Assay).[6] Results: Of 442 cases 410 cases showed INH resistance. Out of which exclusive involvement with inhA was seen in 32 cases. Nineteen cases showed involvement of both inh A and kat G. resistance 359 cases accounting to 87.5% showed exclusive involvement of kat G thereby conferring high degree of resistance. The higher percentage of kat G-induced INH resistance among the RMP resistant strains depicts the spread of a higher degree of INH resistance. The question remains how effective would be the INH prophylaxis in pediatric age group in this scenario. The analysis has shown that only around 14.93% of cases reflected exclusive mutations at around 15 and 16 regions of the inhA gene. The presence of both the Wild and mutant gene segments simultaneously (WT and MUT3) accounted to a percentage of 60.3% among the inh A-dependent INH resistance.
  1,601 129 -
Tuberculosis case detection rate: An observation on the change in 12-year period (2005–2016)
Beuy Joob, Viroj Wiwanitkit
July-September 2019, 3(3):192-195
Background: Tuberculosis is an important problem that causes the public health problem in several countries. The case detection is an important process for early diagnosis and management of disease. The case detection is still the important problem in several settings including Thailand. Methods: The authors appraised on the official report on the tuberculosis detection rate in Thailand comparing between 20005 and 2016, a 12-year-period under the implementation of active tuberculosis case searching campaign. Results: Comparing to the previous reported rate in 2005, 76%, there is no statistically significant different rates (proportional t-test, P > 0.05). Conclusion: The problem of tuberculosis case detection is still observable. There is a need for searching for the additional method for increasing the tuberculosis detection rate.
  1,247 109 -
Cost-effectiveness analysis of classical sputum examination versus molecular diagnosis by genexpert test for tuberculosis screening among the elderly
Pathum Sookaromdee, Viroj Wiwanitkit
July-September 2019, 3(3):210-211
  1,183 155 -
Change of diagnosis of tuberculosis after starting antituberculosis medication: An observation and expected rate of missed diagnosis in a Thailand–Myanmar border district
Pathum Sookaromdee, Viroj Wiwanitkit
July-September 2019, 3(3):189-191
Background: Tuberculosis is still a big problem in several areas including Indochina. The international border area between countries in this area has a high incidence of tuberculosis. There is a need for good surveillance and management for this specific location in Indochina. Methods: The authors reappraise on the available record on tuberculosis case in a Thai border district to Myanmar. The expected missed diagnosis rate of tuberculosis based on the change of diagnosis after starting antituberculosis medication is calculated. Results: The expected range of change of diagnosis of tuberculosis after starting antituberculosis medication is between 4.0% and 64.1%. Conclusion: The missed diagnosis of tuberculosis in this border area can be expected, and this might be a factor leading to incorrect epidemiological data of tuberculosis in this endemic area.
  1,182 108 -