Sanjeev Das

Phase II clinical trial of a vas deferens injectable contraceptive for the male

Following up on an earlier clinical trial demonstrating the safety of an intra-vas deferens injection of a contraceptive drug named Risug, comprised of styrene maleic anhydride (SMA) in a solvent vehicle of dimethylsulphoxide (DMSO), a study to assess the contraceptive effectiveness of a specific dose (60 mg) of SMA bilaterally was planned and implemented. Male subjects and their wives with normal reproductive profiles were the volunteer subjects. The wives were not using any contraceptives. The results reconfirm the safety and show that for a period of at least 1 year, the treatment leads to azoospermia in the male and gives pregnancy protection.

Evaluating contraceptive choice through the method-mix approach: An Indian Council of Medical Research (ICMR) Task Force study

The method-mix approach was used to evaluate informed contraceptive choices in the present study. A total of 8,077 potential clients were given a balanced presentation of all available contraceptive methods in the national program, ie, the CuT 200 intrauterine device (IUD), low-dose combined oral pills (OC), condom, and sterilization (female/male) along with a new method, Norplant(R).(1) The majority of women opted for spacing methods; among them, the IUD was preferred by about 60% of clients, followed by condoms (9%), OC (6%), and Norplant (5%). Sterilization, mainly female, was accepted by about 17% of the women making an informed choice. The economic status of couples did not influence the contraceptive choices, as all the methods were offered free of cost in the present study, which is the current practice in the national program. Illiterate women more often accepted sterilization (about 25%) than did literate women (15%). This is because illiterate women had more children; about 30% of illiterate women had three or more children, as opposed to 16.2% of literate women. However, literacy status did not influence the choice of any specific spacing method. The study also revealed that, by encouraging potential clients to make an informed choice, they could override the providers bias while accepting a particular type of spacing method. This is evident from the observation that Norplant was the first choice of the provider for 35% of the women, whereas only 5% of women preferred and accepted Norplant. The present study stresses an urgent need to promote the practice of informed choices in the national program with a variety of contraceptive options-especially, spacing methods for improving contraceptive prevalence and reproductive health in the country.

Two-year clinical efficacy trial with dose variations of a vas deferens injectable contraceptive for the male

Abstract Contraceptive action of a single intra–vas deferens injection of a specific preparation of styrene maleic anhydride (SMA) dissolved in dimethyl sulphoxide, forming a drug given the name Risug®, has been demonstrated earlier. Now fertility control over a 2-year period with doses having the SMA component ranging from 40 to 70 mg is reported here. The results suggest that pregnancy protection is obtained both in the azoospermic and non-azoospermic states. Side effects are minimal and transient in nature. Libido remains unaltered.

An Initial Study on Normal Commensel Flora of Throat

Introduction: The normal throat flora of humans is complex and consists of several species of bacteria. Materials &Methods: The study aimed at finding out the normal commensel flora of throat of healthy individual in a tertiary care hospital with 157 selected individuals of different ages and both sexes over a period of three months (January 2015 to March2015). Diagnosed cases of immunocompromisation were excluded from the study. Aseptically collected throat swabs were processed for microbiological workup as per standard protocols. Speciation and antimicrobial susceptibility testing of the isolates were done by VITEK-2 Advanced Expert System. Data were analyzed as per standard statistical methods. Results: Amongst study population, Staphylococcus aureus was isolated in 71 cases (45.22%), viridans group of Streptococcus (Streptococcus mitis )was isolated from 93 cases (59.23%)and Diphtheroids were isolated in 29 cases (18.47%). Moraxella sppwere isolated in 17 cases(10.82%). Streptococcus pneumoniae was isolated in 13 cases (0.08%) and Candida albicanswas isolated in 9 cases(0.057%). Polymicrobial isolations were associated in 139 cases (88.53%). All of the Streptococcus isolates were sensitive to Penicillin and Erythromycin. All isolated Staphylococcus aureus were sensitive to Vancomycin and Linezolid. Amongst 71 isolated Staphylococcus aureus, 19 were Methicillin resistant (26.76%). Candida isolates were sensitive to Fluconazole and Itraconazole. Candida albicans was isolated from study group belonging to below 10 years and above 60 years. Moraxella spp. was isolated from the age group of 21years to 40 years. ViridansStreptococcus and Mthicillin Resistant Staphylococcus aureus were isolated from the study population aged ≥10 years. Conclusion: Viridans group of Streptococcus is the leading microbe to form the commensal flora of throat specially after 10 years.

Recent Epidemiological Trend of Dengue in A Teriary Care Hospital in Kolkata

Dengue virus infection has emerged as notable public health problem in recent decades because of high mortality and morbidity associated with it. Dengue with its two severe clinical manifestations dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) is endemic in India and epidemics are frequently reported from many parts of India and abroad. Dengue fever is a recurrent problem in West Bengal. The present study had concentrated on the epidemiology and trend of Dengue fever in a tertiary care hospital of Kolkata Blood was collected aseptically from 7141 clinically suspected patients over a period of four years ,attending the hospital & suffering from fever for at least five days & serum was separated and analyzed by IgM capture ELISA technique to detect Dengue specific IgM antibodies. 789 out of 7141 samples were found to be reactive (11.04 %) and total of 493 cases were male (62.48%) whereas 296 cases were female (37.52%). Majority of the cases (46.9%) were in the age group 10 to 29 years. A clear post rainy season peak was noted in each year during the study period. There was a rise of number of Dengue cases in 2012, then a fall in 2013 and again a sharp peak was noted in 2015.Dengue IgM sensitivity among the suspected cases indicates active dengue virus activity. Further Studies like Haemagglutination inhibition test need to be done to identify circulating serotypes of dengue virus to design preventive strategies

Phenotypic Detection of AAC(6 ' )-Ib-Cr Expression in Enterobacteriacae Isolates

Background: Quinolone resistance in Enterobacteriaceae usually results from mutations in genes carried by chromosomally encoded type II topoisomerases, efflux pumps, or porin-related proteins. Since 1998, plasmid-mediated quinolone resistances (PMQR) have been described. Recently, a new mechanism of transferable quinolone resistance was reported: enzymatic inactivation of certain quinolones. AAC(6′)-Ib-cr is a variant of AAC(6′)-Ib which encodes an aminoglycoside acetyltransferase that confers reduced susceptibility to ciprofloxacin or norfloxacin.. PMQR determinants are often combined with extended-spectrum beta-lactamases (ESBLs) leading to organisms possessing multi drug resistance. Aims & Objectives: To study the incidence of AAC(6′)-Ib-cr expression in Enterobacteriacae isolates by phenotypic method and to find any correlation between the genetic expression of AAC(6′)-Ib-cr along with ESBL production. Materials and methods: The 430 clinical Enterobacteriaceae isolates exhibiting ciprofloxacin and norfloxacin resistance were included in this study. They were grown in Luria-Bertani Broth ( LB broth) containing norfloxacin (8 µg/ml), with intermittent shaking for 18 h at 35°C. Ten microliters of each culture medium was applied on the blank disk set on a Mueller-Hinton agar plate inoculated with E. coli ATCC 25922 and incubated for 18 h at 35°C. A significant decrease of a growth-inhibitory zone by ≥ 10 mm was considered as a positive test for the production of aac(6′)-Ib-cr, while aac(6′)-Ib-cr production was considered not to be produced in strains which did not show any reduction in the zone of inhibition. Results: The overall expression of the AAC(6′)-Ib-cr did not show much variation with almost half of the isolates from all the different samples showing AAC(6′)-Ib-cr production with blood isolates showing a production as high as 66.77%.). A significant association was noted with ESBL production and the simultaneous expression of AAC(6′)-Ib-cr in both E.coli (P value <0.0001) and K.pneumoniae isolates (P value = 0.0137 )which were the two most predominant isolates in the study. A significant association (P value 0.0442) was observed between aminoglycoside resistance and AAC(6’)-Ib-cr expression in E.coli isolates only, while no significant association was observed (P value= 0.7763) in K. pneumonia isolates. Conclusion: AAC(6′)-Ib-cr, though being a recently described gene has high degree of expression in Enterobacteriaceae isolates, which not only confers resistance to fluroquinolones and aminoglycosides but also is coexpressed with ESBL genes, thus producing a scenario of multi drug resistant organisms, further increasing the burden on our limited armamentarium against these bacteria.

Bacteriological profile of corneal ulcer with references to Antibiotic susceptibility in a tertiary care hospital in West Bengal

Over one year, 80 OPD patients with corneal ulcers were scraped from the margins & base of the anaesthetized cornea & smear prepared for Gram staining & 10% KOH preparation. Blood agar for both aerobic & anaerobic, Mac-Conkey Agar, Chocolate Agar were inoculated. Turbidity in brain heart infusion were identified by Gram Stain & subsequently sub-cultured in Mac-Conkey & blood agar. Anaerobic jar containing the blood agar plates were incubated at 37 o C & examined after 48-72 hrs, & finally for 5 days & examined on alternative days before discarding. Further microbiological identification done as per standard protocol. All the isolated bacteria tested against different antimicrobial agents by standard disc diffusion method in accordance with CLSI guideline 2012. Out of 80 cases, corneal ulcer showed male preponderance (3:1) the highest no.19 (23.75%) cases were in the age group of 51-60 years. A total of 40 positive cultures were aerobes.12 specimens for anaerobic culture showed no growth. Among the isolates 19 (46.34%) were Staphylococcus aureus, 13 (31.7%) were CONS, 5 (12.19%) were Pseudomonas, 3 (7.31%) were E. Coli & 1 (2.43%) was Klebsiella. Gram positive cocci were maximally sensitive to Vancomycin, Tobramycin with highest resistance to Ciprofloxacin (55.87% sensitive). Gram negative isolates were maximally sensitive to Chloramphenicol & Moxifloxacin & resistant to Norfloxacin (44.44% sensitive). Routine microbiological examination of corneal ulcer is necessary to analyse & compare the changing trends in the microbial etiology & their susceptibility pattern to formulate a proper & appropriate antibiotic response against corneal ulcer.

The immune-modulating role of Potassium iodide on an ANA- Ease ELISA mode taking a positive sera for ANA (Anti-nuclear Abs) of the IgG isotype

Background : Selective in-vivo anti-fungal action of Potassium iodide (KI) is an enigma, but circumstantial evidences strongly indicate some immune mechanism. Aim : To demonstrate in-vitro immune-modulating role of KI. Materials & methods : 31 sample ( patient sera) collected for the detection of ANA (Anti-nuclear Abs) of the IgG serotype. Taking the positive sample, for each time ,KI solution (0.4%) was given at a different step ( before the addition of conjugate, substrate , before & after the addition of doubly diluted patient sera ) of the assay procedure, to note any significant change in the final O.D. reading, which is directly proportional to the antibody activity in the sample. Procedure repeated for five times & the average result was considered. Procedure repeated with inert carbon particles showed no visible change in O.D. value. Results : KI when introduced after addition of the doubly diluted patient sera ,the graphical interpretation showed that with increasing 2-fold serial dilution of patient sera, the corresponding O.D. read at 450 nm, almost showed a steady fall. Conclusion: KI probably imparts it’s immune-modulating action by structural reformation of Ig molecule, explained in terms of affinity, that decreases proportionately with increasing 2-fold serial dilution of patient sera, with steady fall in the O.D. reading. Such immune-modulation may be related with therapeutic efficacy of this drug when used for clinical conditions, particularly, when no direct anti-microbial role of iodide is established.