The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Dr. Robert Tauxe - Public Health Concerns About Resistant Foodborne InfectionsJohn Blue
Public Health Concerns About Resistant Foodborne Infections - Dr. Robert Tauxe, Deputy Director, Division of Foodborne, Waterborne and Environmental Infections, Centers for Disease Control and Prevention, from the 2013 NIAA Symposium Bridging the Gap Between Animal Health and Human Health, November 12-14, 2013, Kansas City, MO, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2013-niaa-antibiotics-bridging-the-gap-animal-health-human-health
Dr. Robert Tauxe - Antimicrobial Resistance and The Human-Animal Interface: T...John Blue
Antimicrobial Resistance and The Human-Animal Interface: The Public Health Concerns - Dr. Robert Tauxe, Deputy Director, Division of Foodborne, Waterborne and Environmental Diseases, US Centers for Disease Control and Prevention, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
Dr. Robert Tauxe - Public Health Concerns About Resistant Foodborne InfectionsJohn Blue
Public Health Concerns About Resistant Foodborne Infections - Dr. Robert Tauxe, Deputy Director, Division of Foodborne, Waterborne and Environmental Infections, Centers for Disease Control and Prevention, from the 2013 NIAA Symposium Bridging the Gap Between Animal Health and Human Health, November 12-14, 2013, Kansas City, MO, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2013-niaa-antibiotics-bridging-the-gap-animal-health-human-health
Dr. Robert Tauxe - Antimicrobial Resistance and The Human-Animal Interface: T...John Blue
Antimicrobial Resistance and The Human-Animal Interface: The Public Health Concerns - Dr. Robert Tauxe, Deputy Director, Division of Foodborne, Waterborne and Environmental Diseases, US Centers for Disease Control and Prevention, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Food-borne diseases, including food-borne intoxications and food-borne infections, are terms applied to illnesses acquired through consumption of contaminated food, and are also frequently referred to as food poisoning.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
The Eradication of Bovine Tuberculosis In WisconsinDr. Fred J. Born
This PowerPoint covers the history of bovine TB and the changes in the testing cattle for this disease. Describes the important role Wisconsin veterinarians made in the eradication of bovine TB in Wisconsin and the nation.
A complete series of photos of the instruments used
in testing cattle for bovine TB are shown.
Diagnostic tools to detect pathogens causing tuberculosis in cattle and prev...ExternalEvents
Diagnostic tools to detect pathogens causing tuberculosis in cattle and prevent their transmission through dairy products to humans presentation by Flábio Ribeiro de Araújo, Empresa Brasileira de Pesquisa Agropecuária, Campo Grande, Brazil
Disinfection of Mycotic Species Isolated from Cases of Bovine Mastitis Showin...CrimsonpublishersCJMI
Disinfection of Mycotic Species Isolated from Cases of Bovine Mastitis Showing Antifungal Resistance by Elaine Meade in Cohesive Journal of Microbiology & Infectious Disease
Splenic Abscess: Etiology, clinical spectrum and Therapyiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Food-borne diseases, including food-borne intoxications and food-borne infections, are terms applied to illnesses acquired through consumption of contaminated food, and are also frequently referred to as food poisoning.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
The Eradication of Bovine Tuberculosis In WisconsinDr. Fred J. Born
This PowerPoint covers the history of bovine TB and the changes in the testing cattle for this disease. Describes the important role Wisconsin veterinarians made in the eradication of bovine TB in Wisconsin and the nation.
A complete series of photos of the instruments used
in testing cattle for bovine TB are shown.
Diagnostic tools to detect pathogens causing tuberculosis in cattle and prev...ExternalEvents
Diagnostic tools to detect pathogens causing tuberculosis in cattle and prevent their transmission through dairy products to humans presentation by Flábio Ribeiro de Araújo, Empresa Brasileira de Pesquisa Agropecuária, Campo Grande, Brazil
Disinfection of Mycotic Species Isolated from Cases of Bovine Mastitis Showin...CrimsonpublishersCJMI
Disinfection of Mycotic Species Isolated from Cases of Bovine Mastitis Showing Antifungal Resistance by Elaine Meade in Cohesive Journal of Microbiology & Infectious Disease
Splenic Abscess: Etiology, clinical spectrum and Therapyiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Inflammatory Bowel Disease (IBD) is a multifactorial disorder with many different putative influences mediating disease onset, severity, progression and diminution. Spontaneous natural IBD is classically expressed as Crohn’s Disease (CD) and Ulcerative Colitis (UC) commonly found in primates; lymphoplasmocytic enteritis, eosinophilic gastritis and colitis, and ulcerative colitis with neuronal hyperplasia in dogs; and colitis in horses. Spontaneous inflammatory bowel disease has been noted in a
number of rodent models which differ in genetic strain background, induced mutation, microbiota influences and immunopathogenic pathways. Histological lesions in Crohn’s Disease feature noncaseating granulomatous inflammation while UC lesions typically exhibit ulceration, lamina propria inflammatory infiltrates and lack of granuloma development. Intestinal inflammation caused by CD and UC is also associated with increased incidence of intestinal neoplasia. Transgenic murine models have determined underlying etiological influences and appropriate therapeutic targets in IBD. This literature review will discuss current opinion and findings in spontaneous IBD, highlight selected transgenic rodent models of IBD and discuss their respective pathogenic mechanisms. It is very important to provide accommodation of induced putative deficits in activities of daily living and to assess discomfort and pain levels in the face of significant morbidity and/or mortality in these models. Epigenetic, environmental
(microbiome, metabolome) and nutritional factors are important in IBD pathogenesis, and evaluating ways in which they influence disease expression represent potential investigative approaches with the greatest potential for new discoveries.
In this presentation, we delve into the realm of opportunistic gastrointestinal pathogens, shedding light on the often underestimated threats they pose to human health. These microorganisms, while typically harmless in healthy individuals, can turn perilous in situations where the host's immune system is compromised or when environmental conditions become conducive to their proliferation. We will explore the factors that render individuals susceptible to these infections, ranging from immunosuppression to suboptimal hygiene practices. By understanding the key players in opportunistic infections, including notorious culprits like Clostridium difficile, Candida species, Norovirus, and Giardia, we aim to equip our audience with valuable insights for prevention and management strategies. Join us in this journey as we unmask the covert adversaries within our gastrointestinal tract.
Emerging and re-emerging diseses part2 (INCLUDES ANTIMICROBIAL RESISTANCE)Dr. Mamta Gehlawat
2nd half of my ppt on emerging and re-emerging diseases. i uploaded the first half already. pls refer to that too. this ppt has info on AIDS/HIV, ZIKA, EBOLA-MARBURG, MELIODIOSIS, CHOLERA and ANTIMICROBIAL RESISTANCE
Congenital Agenesis Of The Corpus Callosum With Intracerebral Lipoma And Fron...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
“Hemodynamic and recovery profile with Dexmedetomidine and Fentanyl in intrac...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Correlation of Estrogen and Progesterone Receptor expression in Breast Canceriosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Analytical Study of Urine Samples for Epidemiology of Urinary Tract Infection...iosrphr_editor
The current study was carried out in District Abbottabad aimed to determine the common urinary
tract infections in local community to determine the epidemiology of significant diseases in asymptomatic patients
of renal disorder. In this study a total of 1000 urine samples were examined during 3rd February to 1st April 2015
from patients attending Ayub Teaching Hospital Abbottabad by using dipstick and microscopic analysis of urine.
There were 638 females and 362 males patients examined during this period. The range of age groups is between
1.5 years to 80 years. Results of this study was reported as Pyuria 11%, Proteinuria 21.1%, Hematuria 10.4%,
Epithelial Cells 8.2%, pH 7.8 %, Granular casts 7.3%, Triple phosphate 6.6%, Calcium oxalate 6.4%, Glycosuria
6.3%, Bacteria 6.2% and mucous 4.1%. This study concludes that routing urinalysis should be performed for all
individuals to diagnose the asymptomatic diseases that will help in simple therapeutic measurements as urinalysis
is a simple step to determine the root of Urinary tract disorders.
Chest sonography images in neonatal r.d.s. And proposed gradingiosrphr_editor
BACKGROUND : Lung sonography has been used to monitor the patients of R.D.S. in
N.I.C.U. in recent times.
AIMS : To Describe and Grade the changes of R.D.S. by lung sonography.
SETTING & DESIGN : Tertiary care institutional set up in a rural medical college.
STUDY DURATION : September 2014 to May 2015. Follow-up variable, upto 2 weeks.
PROSPECTIVE, ANALYTICAL STUDY.
MATERIALS AND METHODS -This was a single institute study approved by the institutional ethics
committee. Prior informed consent was obtained from the parents. 100 consecutive patients admitted in
N.I.C.U. WITH gestational age < 36 weeks with respiratory complaints were enrolled. Chest x-ray was
obtained within few hours of admission and lung sonography was performed within 24 hours. Follow – up
sonography was performed as and when necessary. Sonography image was graded and correlated with chest
xray and clinical picture
The Comprehensive Review on Fat Soluble Vitaminsiosrphr_editor
This review article deals with brief description of fat soluble vitamins with figures and tables
showing statistical analytical data duly quoting the references wherever necessary. The word “soluble” actually
means “able to be dissolved.” Whether a vitamin is classified as 'fat-soluble' or 'water-soluble' has to do with
how the vitamin is absorbed, stored and removed from the body. Vitamins are tiny organic compounds with a
huge impact on the health and well-being of the body. The body needs a small amount of fat soluble vitamins in
order to stay in optimal health. Fat soluble vitamins play an important role in keeping the body healthy and
functioning from immune system and muscle and heart function, easy flow and clotting of blood as well as eye
health. They are critical to health and wellness–particularly reproductive health and wellness. Low-fat, no-fat
and vegan diets are woefully lacking in fat soluble vitamins. However a diet based on traditional foods can
naturally provide these vitamins. Science is still learning about many of the functions of vitamins. "Too much
vitamin A, D, or K can lead to increased levels that are unhealthy and can cause serious health consequences.
Diseased conditions leading to decreased fat absorption leads to decreased absorption of vitamins. The fatsoluble
vitamins work most safely and effectively when obtained them from natural foods within the context of a
diet rich in all their synergistic partners. If fat soluble vitamins are stored for lengthy time they generate threat
for toxicity than water soluble vitamins and such situation even aggravated, provided they are consumed in
excess. Vitamin products, above the legal limits are not considered food supplements and must be registered as
prescription or non-prescription (over-the-counter drugs) due to their potential side effects. Vitamin A and E
supplements do not provide health benefits for healthy individuals, instead they may enhance mortality, and it is
held proved that beta-carotene supplements can be harmful to smokers
Sulphasalazine Induced Toxic Epidermal Necrolysis A Case Reportiosrphr_editor
Toxic Epidermal Necrolysis (TEN) is a rare and life threatening mucocutaneous reaction
characterized by extensive necrosis and detachment of epidermis. The Worldwide incidence of TEN is 0.9 to 1.4
per million populations per year [1]. Here we have discussed a case of Toxic Epidermal Necrolysis secondary
to Sulfasalazine managed with fluid replacement, analgesics, anti-infective therapy aggressive nutritional
support and intravenous high dose steroid therapy.
Keywords- Toxic Epidermal Necrolysis, Sulfasalazine
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
FIBROLIPOMATOUS HAMARTOMA OF ULNAR NERVE: A RARE CASE REPORT.iosrphr_editor
Nervous fibrolipomatous hamartoma is said to be a rare tumor-like condition involving the peripheral
nerves,in which the epineurium and perineurium are enlarged and distorted by excess of fatty and fibrous tissue
s that infiltrate between and around nerve boundaries. The median nerve is more likely to develop a hamartoma
than other nerves with a predilection for the carpal tunnel.
A fibrolipomatous hamartoma – is a rare, benign, congenital lesion most commonly found in the median nerve,
usually at the level of the wrist or hand.
We report a case of this rare condition in ulnar nerve.
SELF MEDICATION PRACTICES FOR ORAL HEALTH PROBLEMS AMONG DENTAL PATIENTS IN B...iosrphr_editor
Introduction: Self‑ medication is commonly practiced all over the world. Self-medication is defined as the use
of medication by a patient on his own initiative or on the advice of a pharmacist or a lay person instead of
consulting a medical practitioner. The present study was aimed to estimate the prevalence of self-medication for
oral health problems among dental patients in Bengaluru city; to identify triggering factors that could influence
self-medication practices; to identify sources of medications used; to identify sources of information about
medications used; and to identify reasons for self-medication.Study Design: A Cross sectional Study.Methods:A
survey was conducted among 175 subjects among dental patients in Bengaluru city. Data were collected
through a specially designed proforma using a closed‑ ended, self‑ administered questionnaire containing 15
questions, in five sections.
Results: The prevalence of
Clinico-haematological Profile of Falciparum Malaria in a Rural Hospital of T...iosrphr_editor
Aim: To study the clinico-haematological profile malaria in a rural hospital of Tripura.
Material and methods: A cross-sectional hospital-based study was done from at Kulai District
Hospital,Tripura. This hospital based cross sectional study was done on 60 confirmed cases of falciparum
malaria (either by peripheral smear or rapid diagnostic test) admitted in Kulai District Hospital. A case sheet
proforma was prepared and data (demographic profile,clinical feature, investigation, treatment, and
complication) from all indoor patients was collected and analyzed.
Result: Out of 60 patients, 40(66.6%) were males and 20 (33.4%) were females. Most of the patients were
between the age group 21-40 years with the highest prevalence between the age group of 21-30. Fever was the
most common symptom. Anemia was present in 42(70%) patients, out of which 6(10%) patients had severe
anemia. Thrombocytopenia was present in 36(60%) patients.Abnormal liver function tests were observed in
26(43.3%) subjects while abnormal kidney function tests were observed in16(26.6%) patients. All the 60
patients received Artemisinin based antimalarial drugs.
Conclusion: Early detection, prompt management, and adequate supportive therapy may reduce mortality due
to falciparum cerebral malaria.
Indonesian Wild Ginger (Zingiber sp) Extract: Antibacterial Activity against ...iosrphr_editor
Lempuyang gajah (Zingiber zerumbet (L.) Smith), lempuyang pahit (Zingiber amaricans BL.), and
lempuyang wangi (Zingiber aromaticum Vahl.) are used as traditional medicine (jamu) in Indonesia. It is also
used for treatment of microbial infections, helps to increase appetite and stimulate digestion in chickens.
Information on their uses are available, but only limited in the scientific data on their bioactivity. The study was
conducted on the antibacterial effect of organic extracts of these plants with Mycoplasma gallisepticum as the
agent of chronic respiratory disease in chickens. Juice and extracts of fresh and dried rhizome are evaluated
through the disc diffusion assay and minimum inhibitory concentration. Oxytetracyclin (30 µg) are used as
standards. All extracts are individually exhibited as antibacterial activity against Mycoplasma gallisepticum (7
± 0.11 mm to 21 ± 0.86 mm). The minimum inhibitory concentration (MIC) determination of plants extracts are
ranged from 7.8 mg/ml to 31.2 mg/ml. The preliminary results suggested promising antibacterial properties of
wild ginger from Indonesia, and probably could be used in management of chronic respiratory disease in
chickens.
A case of allergy and food sensitivity: the nasunin, natural color of eggplantiosrphr_editor
Abstract: Allergies and food sensitivities can both be considered as "adverse reactions individualistic" to food.
Are pathological and individual forms because they affect a few individuals in way rather serious; immediate
or delayed reactions occur instead with simple effects histamine, or, in severe cases with respiratory and
anaphylactic shock
The eggplant (Solanum melongena L.) is known to cause food allergies in some Asian countries, but detailed
studies on allergies caused by eggplant are lacking, however, it was highlighted the presence of allergens in
edible parts of eggplant with preponderance in the peel .
The purpose of this study was to propose an extraction method rapid, efficient and cost of natural dye from
waste products from the food industry, such as the peels of eggplant, from which it was extracted, isolated and
purified the nasunin,a colored molecule in red-fuchsia.
Nasusin was tested on 58 patients to evaluate the potential sensitizing effect on the skin. The results demonstrate
that allergenic effects are negligible and therefore the nasunin can be used as a colorant in various industrial
sectors with a certain safety margin
Complete NMR Assignment of MogrosidesII A2, II E andIII A1Isolated from Luo H...iosrphr_editor
NMR analysis allowed complete assignments of three known mogrol glycosides, Mogroside IIA2 (1),
II E (2)and IIIA1 (3), isolated from the extracts of Luo Han Guo. Herein, complete 1H and 13C NMR
assignmentsof all threemogrosidesare described based on NMR experiments (1H NMR, 13C NMR, COSY,
HSQC-DEPT, HMBC, NOESY and 1DTOCSY) and mass spectral data.
Nanoemulsion and Nanoemulgel as a Topical Formulationiosrphr_editor
: Nanoemulsion is referred type of emulsion with uniform and extremely small droplet size in the range
of 20-200 nm. Nanoemulsion provides numerous advantages over other carrier such as polymeric nanoparticle
and liposomes, including low cost preparation procedure, high hydrophilic and lipophilic drug loading system
to enhance the longer shelf live upon preserving the therapeutic agents. Incorporating the preparation of
nanoemulsion with hydrogel matrix to produce nanoemulgel exhibited by the two separate systems that forming
it. Nanoemulgel possesses the properties of thixotropic, non-greasy, effortlessly spreadable, easily be removed,
emollient, not staining, soluble in water, longer shelf life, bio-friendly, translucent and agreeable appearance.
Pharmacokinetics of High-Dose Methotrexate in Egyptian Children with Acute Ly...iosrphr_editor
Aim:Since several factors have been shown to influence the clearance of methotrexate, the purpose of this study
was to identify potential relationships between patient covariates and the methotrexate clearance estimates and
deduce a pharmacokinetic model for the estimation of methotrexate clearance in Egyptian pediatric ALL
patients that may help dosage adjustment and achieve target steady-state plasma concentrations in a similar
sittings.
Patients and methods: A total of 94 pediatric patients with B-cell ALL, of whom 70 were the studied population
and 24 were the test population, were treated with four courses of HDMTX doses 2.5 gm/m2
(low-risk arm) or 5
gm/m2
(standard-/high-risk arm) given every other week by intermittent intravenous infusions over 24 hours as
a part of their treatment protocol. Patients were monitored for the 24 hour MTX concentration and the systemic
methotrexate clearance was calculated for each methotrexate dose
Epidemiology of Tuberculosis (TB) in Albania 1998-2009iosrphr_editor
Abstract : In Albania, many people erroneously think that tuberculosis (TB) is a disease of the past-an illness
that no longer constitutes a public health threat. Surveillance is an integral part of tuberculosis (TB) control.
Albania has a highTB notification rate and there are doubts about underreporting. The evolution of the
incidence of tuberculosis is presented, together with more detailed figures over the period 1998-2009. These
figures were obtained by the monthly forms (called 14/Sh) compared with the individual notification data.
Objective: To examine the distribution and sources of increased tuberculosis (TB) morbidity and reporting
system deficiencies in the Albania from 1998 through 2009. Metodology: The study is descriptive one conductet
during the period 1998-2009. The statistical analysis is based on data reported from regional level (regional
epidemiological departments) to the central level (Public Health Institute). Results: The main findings were:
discordance between the collected data (individual form) and reported data (monthly form); tuberculosis
incidence rate shows little oscillations which ranges from 6.67 to 9.2 cases/100.000 population; 50% of the
regions show a lack of information on the confirmation of diagnosis and laboratory examination type used for
confirmation. Conclusion: TB disease in high-risk populations where it is difficult to detect, diagnose, and treat;
limitations of current control measures and the need for new tests and treatments, including an effective
vaccine; improving information system, regulation of individual form and personnel training.
Total Phenol and Antioxidant from Seed and Peel of Ripe and Unripe of Indones...iosrphr_editor
Study on total phenol and antioxidantactivity ofsugar apple fruits of various solvent, part of fruits, and level of ripening. Solvent extraction used were 80% (v/v) methanol, 50% (v/v) acetone, boiling water, and 50% (v/v) ethanol. Part of fruits thatbeen used for samples were seed and peel which are normally by products of sugar apple processing, level of ripening were unripe, and ripe sugar apple fruits. Total phenol was determined by Folin-ciocalteau method. Total antioxidant was quantified by 1,1-diphenyl-2-picrylhydrazyl(DPPH) method.Therewas a difference in type of solvent, part of fruits, and level of ripeningon total phenol and antioxidant concentration of sugar apple fruits. Seeds have higher total phenol concentration than peels of this fruits. Unripe sugar apple fruits have higher total phenol and antioxidant than ripe fruit. The best solvent for phenol extraction was ethanol 50%butthe best solvent for antioxidant extraction was acetone 50%.
A Review on Step-by-Step Analytical Method Validationiosrphr_editor
When analytical method is utilized to generate results about the characteristics of drug related samples it is essential that the results are trustworthy. They may be utilized as the basis for decisions relating to administering the drug to patients. Analytical method validation required during drug development and manufacturing and these analytical methods are fit for their intended purpose. To comply with the requirements of GMP pharmaceutical industries should have an overall validation policy which documents how validation will be performed. The purpose of this validation is to show that processes involved in the development and manufacture of drug, production and analytical testing can be performed in an effective and reproducible manner. This review article provides guidance on how to perform validation characteristics for the analytical method which are utilized in pharmaceutical analysis.
A Cross Sectional Study of Ethnic Differences in Occurrence and Severity of A...iosrphr_editor
Non-steroidal anti-inflammatory drugs are the most widely used "over the counter" medication all over the world despite their complications in different major organs. Present studies envisaged for knowing the occurrence and severity of adverse drug reactions from NSAIDs in different ethnic communities of Sikkim. A cross sectional study was undertaken in the medicine outpatients department of a secondary and tertiary care hospital. The patients belonging to Nepalese, Bhutias, Lepchas ethnic communities and others community (settlers from other parts of India) were included to analyzed the data based on the age and gender, ethnicity and ADRs, drugs and ADRs. Severity assessment was done using Hartwing and Siegel scale and causality assessment by Naranjo scale. Total 109 cases of ADRs, predominating in female were detected. Nepalese were the most affected and Gastrointestinal tract (GIT) being the most affected organ in them. Diclofenac showed maximum number of ADRs in all the communities. Maximum number of cases occurred on single day use (40.36%) of drugs. All the cases were belonging to the "possible category" and the maximum being the mild (72.48%) in nature. It is advisable to consider the ethnic/racial differences equally with other factors, to improve the safety and efficacy of a drug.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ocular injury ppt Upendra pal optometrist upums saifai etawah
E045029034
1. IOSR Journal Of Pharmacy
(e)-ISSN: 2250-3013, (p)-ISSN: 2319-4219
www.iosrphr.org Volume 4, Issue 5 (May 2014), PP. 29-34
29
Clostridium Difficile infection and Antibiotic –Associated Colitis
Murtaza Mustafa1
,Muhammad Iftikhar2
,Saima Shafi3
,Malik J.Shah4
1,2,4
Faculty of Medicine&,Health Sciences, University Malaysia Sabah,KotaKinabalu,Sabah,Malaysia
3
, Hospital Queen Elizabeth,Kota Kinabalu, Sabah, Malaysia
ABSTRACT:Hospitalized patients receiving β lactam antibiotics develop diarrhea and higher rates reported
in those receiving clindamycin. Clostridiumdifficile is recognized as a cause of antibiotic associated diarrhea,
colitis and pseudomembranous colitis. Contributory factors include: advance age, severity of underlying
illness.C.difficile has the ability to temporarily colonize newborn humans and calves, suggests that the
gastrointestinal tracts of young animals may be a major reservoir.C.difficile is recognized enteric pathogen in
animals including companion animals and food animals. Clinical features include: asymptomatic carriage in
neonates to a fulminant, relapsing, and occasionally fatal colitis. Initial therapy for pseudomembranous colitis
includes discontinuation of offending antibiotic regimen, fluid replacement and electrolyte losses. Mild to
moderate infection with metronidazole,severe to recurrent cases with vancomycinTherapy with probiotic such
as Sacchromyces boularadii is beneficial. Antibiotic misuse in humans and production animals must be
addressed.
KEY WORDS:Clostridium difficile, Antibiotic, Colitis, and Diarrhea
I. INTRODUCTION
Antibiotic associated diarrhea and colitis is most common complications of antibiotic therapy.Attack
rates vary depending on the antimicrobial agent used, the epidemiologic setting, and the host. Overall attack
rates antibiotic-associated diarrhea in hospitals rage from 3.2% to 29% [1].Almost 15% of hospitalized patients
receivingβ-lactam antibiotics develop diarrhea and rates for those receiving clindamycin rage from 10% to 20%
[2].Clostridium difficile is now recognized as a frequent cause of antibiotic associated diarrhea and colitis, and
the incidence of C.difficile associated diarrhea seems to be increasing [3].It is implicated in 20% to 30% of
patients with antibiotic-associated diarrhea, in 50% to 75% of those with antibiotic- associated colitis
[4].Literature from the mid-1970s emphasized that attack rates for diarrhea and pseudomembraneous colitis
associated with the use of individual antibiotics. Several studies rates of clindamycin and lincomycin associated
diarrhea ranging from 7% to 21% and rates of ampicillin-associated diarrhea from 4% to17% [5].In the late
1970s,a series of investigations established toxigenic C.difficile as the cause of pseudomembranous colitis
[6].The reported incidence of ofC.difficile in acute-care hospital increased from 30 to 40 cases per 100,000
population in 1990s to 84 per 100,000 by 2005 [7]. Although colonization with toxigenic C.diffiile occurs
frequently among residents of some extended-care and rehabilitation facilities symptomatic disease develops in
only a minority of infected patients [8].Animal studies found that intracecal materials transferred the disease
from affected hamsters to healthy ones that both the cultures of Clostridia and their cell-free supernatants
produced this disease and this activity was neutralized by gas gangrene antiserum [9].Ritkin and associates
reported that stool filtrates from the humans with pseudomembranous colitis were lethal for hamsters; caused
edema,hemorrhage, and increased vascular permeability in rabbit skin and possessed cytotoxic activity that was
neutralized by Clostridium sordelli antitoxin [10]. Emergence of strains causing C.difficile infection in the
community (CA-CDI) is becoming more commonplace [11].Unlike health care infections, CA-CDI is associated
with younger, healthy people, often without prior exposure to antimicrobials or contact with hospitalized
patients [12].The rates of human infection CDI have increased dramatically and C.difficile is recovered from
Australian production animals [13,14].The paper reviews pathophysiology, clinical features, diagnosis and
therapy of antibiotic associated colitis.
II. PATHOPHYSIOLOGY
C.difficle most often causes a nonspecific colitis.However, especially in more severe cases, one may see the
distinct macroscopic appearances of pseudomembranous colitis. The colonic mucosa is studded with
adherent,raised,white and yellowish plaques.Initially,these lesions are small and discrete and are easily
dislodged; the intervening mucosa may be inflamed and covered with mucus, but often it appears entirely
normal [15].With progression of disease, pseudomembranous plaques may enlarge and coalesce. Pseudo-
membranes can exist throughout the entire colon, but they are usually most pronounced in the recto sigmoid
2. Clostridium Difficileinfectionand Antibiotic -----
30
colon; rarely does the disease progress proximal to the ileocecal valve [15].Histological criteria for
pseudomembranous colitis and method for grading lesions have been described. The principal features are
inflamed mucosa with a neutrophil predominance and mucin distended glands. Attached pseudomembranous are
composed of a loose network of mucin, neutrophils, fibrin, and nuclear debris [15].
III. RESERVIORS OF INFECTION
Researchers have documented the prevalence of C.diffficile (or one of its toxins) in 15% to 70% of
neonates [16].Despite the presence of toxin-producing organisms in this population, the prevalence of C.difficile
colitis remain low [17].Enhancement of chemotactic responses of granulocytes to toxin A in older persons and
the absence of high-affinity receptors for toxin A in neonates (in a rabbit model) have been cited as possible
reasons for this age-dependent susceptibility [18,19]. The ability of C.difficile to temporarily colonize newborn
humans, hamsters,and calves suggests that the gastrointestinal tract of very young mammals may be a major
reservoir [19,20].In healthy adults, intestinal carriage rates of toxigenic C.difficle are typically 3% or less and
not greater than 8%.Asymptomatic intestinal carriage rates are higher (-approximately 20%) among hospitalized
adults, particularly those who have received antibiotics [21,22].
C.difficile is a recognized enteric pathogen in a variety of animals including companion animals e.g.
Cats dogs,horses, and food animals (cattle,sheep,goats,pigs)[23].In Australia C.difficile has been isolated from
piglets,sheep,lambs,horses,cats,digs and cattle with the highest prevalence in neonatal animals due to a lack of
established gut flora at birth. For this reason predisposing antibiotics may not be required for development of
CDI in young animals although there is anecdotal evidence in Australia of routine use of extended-spectrum
cephalosporins in production animals. This is particularly concerning in the pork industry where gross
contamination of facilities with C.difficile spores is commonplace with C.difficile [24]. Several meat products,
seafood, ready–to eat salad leaves and vegetables are also contaminated with C.difficile, predominantly ribotype
078-like strains [16].Contamination may occur through spillage of gut contents at slaughter or direct
contamination by food handlers during dressing or retailing. Environmental contamination may also play a role.
C.difficile spores survive in treated piggery effluent, the byproducts of which are often applied to agriculture
land, used in retail compost manufacture, or recycled within swine facility [25].
Outside Australia, the increasing prevalence of PCR ribotype 078 in humans, food production animals
and food products suggest potential zoonotic transmission. In Netherlands,where infections with ribotype 078
increased more than fourfold from 2005 to 2008.patients infected with this ribotype were younger and acquired
C.difficile in the community more frequently particularly if they lived in rural pig producing areas [26]. In the
USA,the prevalence of ribotype 078 infections in humans increased from 0.02% to 1.3%(pre 2001 to 2006) and
ribotype 078 is increasingly associated with CA-CDI.These strains are indistinguishable or very closely related
to animal ribotype 078 strains by PFGE analysis [27].Ribotype 078 strains from Dutch humans and pigs are
indistinguishable by MIVA subtyping [28].Transmission from humans to animals may occur.C.difficile can be
isolated from the feces of hospital pet therapy dogs that had prior negative culture for C.difficile.These dogs
were > 2 times likely to be colonized with C.difficile than dog’s not vising hospital [29].
IV. EXASPERATE AGENTS
Almost all antibiotic classes have been associated with the disease, reports of large clinical series’ most
commonly implicate clindamycin,penicillins,cephalosprins and more recently fluroquinolones [30].Several
noteworthy studies primarily implicated clindamycin and ampicillin in the 1970s [31].In the most recent
outbreaks associated with NAPI/027 (North American pulsed field type 1, ribotype027) which is resistant to
fluoroquinolones,fluoroquinolones are clearly identified as a risk factor for clinical disease [32].Third
generation cephalosporin’s have been implicated in particular and seem to predispose to C.difficile-associated
disease more commonly than do the narrow spectrum penicillin’s or β-lactam-stable penicillin [33].A number of
antineoplastic agents particularly those with modest antibacterial activity,have been associated with C.difficile
diarrheal disease, including doxorubicin, cisplatin,cyclophosphamide and others [34 ].
V. CONTRIBUTORY FACTORS
Antimicrobials use is the primary factor in the disease, but certain host and environmental factors also
predispose to C.difficile-associated disease. In a comprehensive prospective study of risk factors in hospitalized
patients, McFarland and associates[35], identified advance age and severity of underlying illness as factors
associated with increased risk of C.difficile carriage and diarrhea and found that agents that alter normal
intestinal motility-specifically enemas and gastrointestinal stimulants, as well as stool softener-also contribute to
the risk of C.difficle associated diarrhea [35].Given the tendency of this disease to affect ill elderly patients who
receive antibiotics, it is no surprise that patients with C.difficile are also at risk of colonization by vancomycin
resistant enterococci [36].Other investigators have reported that critically ill burn patients, uremic patients,
patients with hematologic malignancies, and those undergoing gastrointestinal surgery are at high risk of
3. Clostridium Difficileinfectionand Antibiotic -----
31
C.diffiile diarrhea and colitis [37-40].Emerging evidence suggests that immunologic susceptibility may play a
critical role in C.difficile-associated infection. Host immunoglobulin G responses have been shown to protect
against symptomatic disease and relapse [41,42].Human deficiency virus (HIV) infection per se does not appear
to predispose to C.difficile colonization and specific risk factors for C.difficile- associated disease among HIV-
infected patients appear to be similar to those HIV seronegative persons [43,44].In recent years CA-CDI has
become more common, and in nearly one fourth of such cases, no traditional risk factor are identified [45]
VI. CLINICAL FEATURES
Infection with toxigenicC.difficile causes a spectrum of disease ranging from asymptomatic carriage
(particularly in neonates) to a fulminant, relapsing, and occasionally fatal colitis. When C.difficile produces
clinical disease, the onset of signs and symptoms typically occurs after 3 to 5 days of antibacterial treatment, but
diarrhea may develop as early as first of therapy or as late as 10 weeks after cessation of therapy [46].C.difficile
diarrhea may be brief and self-limited or it may be cholera like, resulting in more than 20 stools per day
[2].Accompanying findings often include fever (30% to 50% of patients), leukocytosis (50% to 60%) and
abdominal pain or cramping (20% to 33%) [47,48,47].The mean peripheral leukocyte count of patients with
C.difficile-associated diarrhea typically 15,000 to 16,000/mm3
in one series.C.difficle infection was noted in 25%
of patients with white cell counts of greater than of greater than 35,000/mm3
who did not have hematologic
malignancy [49].Nausea, malaise,anorexia, hypoalbuminemia,occult colonic bleeding, and dehydration have
also been reported [2].Infrequently,C.difficile colitis manifests without diarrhea as an acute abdominal syndrome
or toxic megacolon [50].In one report,5 of 97 patients with C.difficile disease(only 1 of whom had profuse
diarrhea) presented initially with marked leukocytosis (white cell count>25,000/mm3
) and right lower quadrant
peritoneal signs mimicking those of acute peritonitis [51].Toxicmegacolon is suggested by acute dilatation of
colon to a diameter greater than 6 cm, associated systemic toxicity, and the absence of mechanical obstruction.
It carries a high mortality rate (64% in one series of 11 patients) [52].Other intra-abdominal complications
include colonic perforation, transverse volvulus, protein-losing enteropathy, and recurrent C.difficile–associated
diarrhea, the last occurring in approximately 20% of patients [53,54,55].Extra intestinal manifestation occur
more rarely and include bacteremia, often with concurrent isolation of other constituent organisms in the bowl
flora, splenic abscess, and osteomyelitis[56,57,58].In addition, multiple reports have described reactive arthritis
or tenosynovitis or both [59,60].
Consideration in the differential diagnosis of antibiotic-associated colitis include diarrhea caused by other
enteric pathogens [especiallySalmonella), adverse reactions to other medications, ischemic colitis, inflammatory
bowel disease, and intra-abdominal sepsis [50].
VII. DIAGNOSTIC METHODS
C.difficile-associated disease should be suspected in patients with diarrhea who have received
antibiotics within the past two months or whose diarrhea begins 72 hours after hospitalization [50].In most
instances, toxin testing or C.difficile culture of a single stool specimen effectively establishes the diagnosis;
however, repeat testing or endoscopy, or both may be necessary
C.difficile toxin detection
The most widely used means of diagnosing C.difficile-associated diarrhea and colitis clinically
detection of C.difficile toxin in stool specimens. The cytotoxicity assay has been considered the gold standard
for diagnosis, but most clinical laboratories use various enzyme immunoassays, which perform reasonably well
compared with cytotoxicity assays [6].Stool filtrate are incubated with mammalian tissue culture cell line with
and without toxin-neutralizing antibody. If toxicity activity, usually manifested as surrounding of cultured cells,
is noted in the well with stool filtrate and toxin-neutralizing antibody, the test for the specimen is considered to
be positive [6].If used in appropriate clinical setting, this test is both sensitive and specific; more than 90% of
patients with pseudomembranous colitis have cytotoxicity in their stool detected by this assay [61].
C.difficile toxin A or B can be detected by enzyme-linked immunobsorbent assay kits, available commercial
kits, their performance characteristics have been studied extensively [62].In general, they are rapid, relatively
inexpensive, and specific, but lack the sensitivity of the technically more cumbersome cytotoxin assays.If
measured against strictest diagnostic criteria that include clinical diarrhea, along with cytotoxin assay and
culture results, their sensitivity rages from 63% to 94 % with a specificity of 75% to 100% [63].
C.difficledetection by culture
Anaerobic culture forC.difficile,the most sensitive test in many laboratories, remains essential
for epidemiologic studies of outbreaks.However, cost and convenience issues have driven many hospital
laboratories to replace routine cultures with more rapid and less expensive enzyme-linked immunosorbent assay
based assays, sometimes in combination with cytotoxinassays. Most clinical microbiology laboratories are not
4. Clostridium Difficileinfectionand Antibiotic -----
32
equipped to distinguish between nonpathogenic, on toxigenic strains, and testing schemes that rely solely om
C.difficile cultures yield a significant number of false-positive results (In some hospitals, 20% to 25% of
C.difficie isolates are non-toxigenic [64].Testing for stool toxin simultaneously or using in vitro toxin
production assays my help to resolve this problem [63].
Endoscopy for detection of pseudomembrane
The detection of exudative plaques or pseudo membranes on colonic mucosa establishes the diagnosis
of pseudomembranous colitis. The pathognomonic lesions is characteristically raised, yellowish, and usually 2
to 10 mm in diameter with “skip” of normal mucosa, but in severe disease, lesions may coalesce to form plaques
[50].At least 90% of patients with pseudomembranous colitis demonstrate either C.difficile or its toxin in stool
samples [48].Because of its cost, risk to the patient, and availability of other diagnostic tests, endoscopy is
usually reserved for special situations [50].
VIII. THERAPY
Treatment of choice in Clostridium difficile-associated diarrhea and colitis for adults include: Initial
therapy for pseudomembranous colitis should commence with discontinuation of the offending antibiotics
regimen, if possible, and replacement of fluid and electrolyte losses. In a prospective treatment trial the diarrhea
resolved before initiation of therapy in 23% of 149 patients, but most patients require specific antibacterial
therapy [65].Therapy of Clostridium difficile-associated diarrhea and colitis for adults begins with replace fluid
and electrolytes, if clinical situations allows, discontinue offending antibiotic, and avoid antiperistaltic agents
plus for mild to moderate infection metronidazole 500 mg orally 3 times daily for 10 to 14 days.In severe
infection or unresponsiveness to or intolerance to metronidazole, vancomycin 125 mg daily 4 times daily for 10
to 14 days. For second recurrence,vancomycin in tapered and pulsed doses a) 125 mg 4 times daily for 14 days,
b)125 mg orally twice daily for 7 days, c)125 mg once daily for 7 days, d) 125 mg orally once every 2 days for
8 days)125 mg once every 3 days for 15 days [15].Other options for recurrent infection include:Vancomycin
followed by rifamiximin,400 mg orally 2 times daily for 14 days. Therapy with probiotic such as Sacchromyces
boulradii[15].
Antiperistaltic agents, such as loperamide and diphenoxylate hydrochloride with atropine should be
avoided. There is little evidence that such agents lead to symptomatic improvement, and in one study predating
the discovery of Clostridumdifficile as a pathogen, diarrhea was actually more common among those receiving
diphenoxylate-atropine plus lincomycin than those receiving placebo plus lincomycin [66].Several ancedotes
and case series have associated the use of diphenoxylate and of lapromide and other anti-peristaltic agents with
the development of toxic mega colon in patients with C.difficiledisease or pseudomembranous colitis [51].
IX. CONCLUSION
Diarrhea and colitis is most common complications of antibiotic therapy.C.difficle causes diarrhea in
humans and animals. Toxigenic C.difficleis also cause of pseudomembranous colitis.CA-CDI strains causing
infection in the community is also common.Antimicrobial use in humans and animals must be addressed.
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