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Kothavade R.J.,Microbiology Laboratory | Kothavade R.J.,Sir JJ Group of Hospitals | Dhurat R.S.,LTMG Hospital Sion | Mishra S.N.,TNMC and BYL Nair Charitable Hospital | Kothavade U.R.,University of Alberta
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2013

Rapidly growing mycobacteria (RGM) are known to cause pulmonary, extra-pulmonary, systemic/disseminated, and cutaneous and subcutaneous infections. The erroneous detection of RGM that is based solely on microscopy, solid and liquid cultures, Bactec systems, and species-specific polymerase chain reaction (PCR) may produce misleading results. Thus, inappropriate therapeutic measures may be used in dermatologic settings, leading to increased numbers of skin deformity cases or recurrent infections. Molecular tools such as the sequence analyses of 16S rRNA, rpoB and hsp65 or PCR restriction enzyme analyses, and the alternate gene sequencing of the superoxide dismutase (SOD) gene, dnaJ, the 16S-23S rRNA internal transcribed spacers (ITS), secA, recA1, dnaK, and the 32-kDa protein gene have shown promising results in the detection of RGM species. PCR restriction enzyme analyses (PRA) work better than conventional methods at identifying species that are closely related. Recently introduced molecular tools such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), pyrosequencing, DNA chip technology, and Beacon probes-combined PCR probes have shown comparable results in the detection of various species of RGM. Closely related RGM species (e.g., Mycobacterium fortuitum, M. chelonae, and M. abscessus) must be clearly differentiated using accurate molecular techniques because their therapeutic responses are species-specific. Hence, this paper reviews the following aspects of RGM: (i) its sources, predisposing factors, clinical manifestations, and concomitant fungal infections; (ii) the risks of misdiagnoses in the management of RGM infections in dermatological settings; (iii) the diagnoses and outcomes of treatment responses in common and uncommon infections in immunocompromised and immunocompetent patients; (iv) conventional versus current molecular methods for the detection of RGM; (v) the basic principles of a promising MALDI-TOF MS, sampling protocol for cutaneous or subcutaneous lesions and its potential for the precise differentiation of M. fortuitum, M. chelonae, and M. abscessus; and (vi) improvements in RGM infection management as described in the recent 2011 Clinical and Laboratory Standards Institute (CLSI) guidelines, including interpretation criteria of molecular methods and antimicrobial drug panels and their break points [minimum inhibitory concentrations (MICs)], which have been highlighted for the initiation of antimicrobial therapy. © 2012 Springer-Verlag Berlin Heidelberg.


Thatte U.,KEM Hospital | Chiplunkar S.,Advanced Center for Treatment | Bhalerao S.,TNMC and BYL Nair Charitable Hospital | Kulkarni A.,MA Podar Ayurvedic Hospital | And 6 more authors.
Indian Journal of Medical Research | Year: 2015

Background & objectives: Basti (medicated enema) is a popular Ayurvedic intervention recommended for obesity. However, there are no data to show whether any physiological or biochemical changes occur following this treatment. This study was conducted to identify the immunological and metabolic changes in obese individuals after a therapeutic course of basti. Methods: Thirty two obese individuals (18 and 60 yr) with a body mass index (BMI) =30 kg/m2 who received a therapeutic course of 16 enemas (basti) followed by a specific diet and lifestyle regimen for a period of 32 days as their treatment for obesity, were enrolled in the study. Clinical examination, measurement of immune and metabolic markers were done before (S1), immediately after (S2) and 90 days after the completion of therapy (S3). Results: A significant reduction (p<0.001) in weight, BMI, upper arm and abdominal circumference was seen at S3, along with a decrease in serum interferon (IFN)-γ (p<0.02), interleukin (IL)-6 (p<0.02) and ferritin (P<0.05) and increase in IgM levels (p<0.02). Peripheral blood lymphocytes (PBLs) stimulated with anti-CD3 monoclonal antibodies showed significant increase in reactive oxygen species (ROS) generation and calcium flux after Basti. All organ function tests revealed no changes. Interpretation & conclusions: Our study documents that a therapeutic course of basti modulates immune responses by regulating pro-inflammatory cytokines, immunoglobulins and functional properties of T-cells. These changes are associated with a reduction in the body weight which is maintained even after three months of treatment. the study also documents the safety of basti procedure. © 2015, Indian Council of Medical Research. All rights reserved.


Gala F.B.,LifeScan | Gala F.B.,University of Zürich | Aswani Y.,TNMC and BYL Nair Charitable Hospital
Indian Journal of Radiology and Imaging | Year: 2016

Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication. © 2016 Indian Journal of Radiology and Imaging | Published by Wolters Kluwer - Medknow.


PubMed | TNMC and BYL Nair Charitable Hospital and University of Zürich
Type: Journal Article | Journal: The Indian journal of radiology & imaging | Year: 2016

Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication.


Joshi K.K.,TNMC and BYL Nair Charitable hospital | Joshi K.K.,Glaxosmithkline | Nerurkar R.P.,TNMC and BYL Nair Charitable hospital | Nerurkar R.P.,Glaxosmithkline
Indian Journal of Physiology and Pharmacology | Year: 2012

Introduction - Many drugs, including serratiopeptidases, are marketed without proven efficacy in clinical trials. It is protein in nature and claimed to be effective orally. Methods - 24 albino wistar rats, 6 each in following groups were assigned - (1) Control group (distilled water, orally) (2) Diclofenac (6.75 mg/kg, IP) (3) serratiopeptidase (5.4 mg/kg, orally) (4) Combination of serratiopeptidase (5.4 mg/kg, orally) and diclofenac (2.25 mg/kg, IP). Inflammatory agent, carrageenan (0.1 ml of 1% w/v) was injected subcutaneously in the ether anesthetized rat hind paw, half an hour after the administration of drug. Rat paw volume up to lateral malleolar process was recorded with plethysmometer at various time periods. Results - Percentage formation and inhibition of oedema in serratiopeptidase or combination groups were not significantly different than control group. Both were significantly less for diclofenac group. Conclusion - Serratiopeptidase was not effective in this animal model of oedema/inflammation.


Dhurat R.P.,TNMC and BYL Nair Charitable Hospital | Deshpande D.J.,TNMC and BYL Nair Charitable Hospital
International Journal of Trichology | Year: 2010

Loose anagen syndrome (LAS) is a benign, self-limiting condition where anagen hairs are easily and painlessly extracted. It is mainly reported in childhood; however, it may variably present in adulthood as well. The presence of anagen hair devoid of its sheath and with 'floppy sock appearance' is a characteristic feature of loose anagen hair (LAH) on trichogram. LAH can be seen in normal population and in alopecia areata. The percentage of LAH in LAS is more than 50%. The histopathological findings show clefting between the layers of hair and are very useful in differentiating LAS from alopecia areata. Here, a review on the diagnostic criteria and practical guidelines are discussed so as to enable the trichologist in managing this benign, self-limiting condition and differentiating it from the other causes of non-scarring alopecias.


PubMed | TNMC and BYL Nair Charitable Hospital
Type: Journal Article | Journal: International journal of trichology | Year: 2011

Loose anagen syndrome (LAS) is a benign, self-limiting condition where anagen hairs are easily and painlessly extracted. It is mainly reported in childhood; however, it may variably present in adulthood as well. The presence of anagen hair devoid of its sheath and with floppy sock appearance is a characteristic feature of loose anagen hair (LAH) on trichogram. LAH can be seen in normal population and in alopecia areata. The percentage of LAH in LAS is more than 50%. The histopathological findings show clefting between the layers of hair and are very useful in differentiating LAS from alopecia areata. Here, a review on the diagnostic criteria and practical guidelines are discussed so as to enable the trichologist in managing this benign, self-limiting condition and differentiating it from the other causes of non-scarring alopecias.

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