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Malaria is a major parasitic disease in tropical and sub-tropical regions. Pertaining to the sustaining resistance in malarial parasite against the available drugs, novel treatment options are the need of the hour. In this resolve recently, focus has shifted to finding the natural alternatives that possess anti-plasmodial activity for combatting malaria. Drawing on the text written in ancient scriptures and Ayurveda, natural compounds are now being screened for their therapeutic properties. Indole is one such natural compound, present in all living organisms, it displays a range of therapeutic activities including anticancer, anti-inflammatory, antimalarial etc. In this review, we have discussed various indole scaffold as well as the semi-synthetic drugs containing indole moiety that have been synthesized for malaria treatment.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder that may be treated with non-ablative light-based devices; however, no systematic reviews on the topic exist to date. We conducted a systematic review and meta-analysis to determine efficacy of non-ablative light-based devices in treating HS. Specifically, a systematic review was conducted using MEDLINE, EMBASE, Web of Science and CINAHL. We analyzed the use of non-ablative light-based devices in the treatment of HS. At least two investigators performed title/abstract review and data extraction. Meta-analysis was conducted using comprehensive meta-analysis software. 5 RCTs and 11 case reports/series were included (n = 211 unique patients). No observational studies were found. For Nd:YAG laser, meta-analysis of 3 RCTs reported improvement in modified HS Lesion Area and Severity Index (HS-LASI) when compared to control subjects. In addition, three case reports/series reported HS-LASI, Physician Global Assessment (PGA) scores and number-of-lesion improvements in treated patients. For intense pulsed light (IPL), two RCTs reported HS-LASI and Dermatology Life Quality Index (DLQI) score improvements. For Alexandrite laser, one case report showed lesion improvement. In conclusion, meta-analysis of Nd:YAG laser in HS patients suggests significant improvement in HS-LASI scores. For IPL, evidence is limited, but suggests improvement in HS-LASI and DLQI scores. For Alexandrite laser, evidence precludes conclusions. Given small sample sizes and inconsistent reporting scales, larger RCTs are required to better determine the efficacy of these modalities in treating HS.

A random assessment of adolescent girls living in the hostels of Kota revealed a disturbing pattern in their eating habits. Their general consumption was erratic and high on empty calories lacking precautions without any heed being paid to the nutritional value of the food being consumed. A sample of 50 girls (16 to 22 years of age) belonging to middle and higher class families was chosen arbitrarily and provided with a questionnaire methodically planned and the responses were assessed taking into consideration the unique pattern of life they were subjected to. Girls living in hostels have to be under a constant stress, resulting out of factors that are beyond their control. Majority of these factors take a gradual toll on the adolescent’s body making her all the more vulnerable to deficiencies and diseases. Around 78% of the respondents admitted to consuming highly calorific food including fries, pizzas, pasta and burgers on an almost regular basis resulting in disorders ranging from obesity to an early diagnosis of diabetes. Around 17% were found to be suffering from hair fall and mildly anemic.

Background: Brain concentrations of omega-3 docosahexaenoic acid (DHA, 22:6n-3) have been reported to positively correlate with seizure thresholds in rodent seizure models. It is not known whether brain DHA depletion, achieved by chronic dietary omega-3 polyunsaturated fatty acid (PUFA) deficiency, lowers seizure thresholds in rats. Objective: The present study tested the hypothesis that lowering brain DHA concentration with chronic dietary n-3 PUFA deprivation in rats will reduce seizure thresholds, and that compared to injected oleic acid (OA), injected DHA will raise seizure thresholds in rats maintained on n-3 PUFA adequate and deficient diets. Methods: Rats (60 days old) were surgically implanted with electrodes in the amygdala, and subsequently randomized to the AIN-93G diet containing adequate levels of n-3 PUFA derived from soybean oil or an n-3 PUFA-deficient diet derived from coconut and safflower oil. The rats were maintained on the diets for 37 weeks. Afterdischarge seizure thresholds (ADTs) were measured every 4-6 weeks by electrically stimulating the amygdala. Between weeks 35 and 37, ADTs were assessed within 1 h of subcutaneous OA or DHA injection (600 mg/kg). Seizure thresholds were also measured in a parallel group of non-implanted rats subjected to the maximal pentylenetetrazol (PTZ, 110 mg/kg) seizure test. PUFA composition was measured in the pyriform-amygdala complex of another group of non-implanted rats sacrificed at 16 and 32 weeks. Results: Dietary n-3 PUFA deprivation did not significantly alter amygdaloid seizure thresholds or latency to PTZ-induced seizures. Acute injection of OA did not alter amygdaloid ADTs of rats on the n-3 PUFA adequate or deficient diets, whereas acute injection of DHA significantly increased amygdaloid ADTs in rats on the n-3 PUFA adequate control diet as compared to rats on the n-3 PUFA deficient diet (P < 0.05). Pyriform-amygdala DHA percent composition did not significantly differ between the groups, while n-6 docosapentaenoic acid, a marker of n-3 PUFA deficiency, was significantly increased by 2.9-fold at 32 weeks. Conclusion: Chronic dietary n-3 PUFA deficiency does not alter seizure thresholds in rats, but may prevent the anti-seizure effects of DHA.

People with epilepsy may have abnormal cardiac function. This has been linked to a greater incidence of sudden unexpected death in epilepsy (SUDEP). In the present review, we assess the evidence linking cardiac failure to SUDEP, and propose the use of the maximal pentylenetetrazol seizure test to model SUDEP in animals to identify causal links between cardiac failure and SUDEP. We also discuss recent claims on the use of omega-3 polyunsaturated fatty acids to reduce the incidence of SUDEP because of their cardioprotective and anticonvulsant effects.

The amalgamation of the research efforts of biologists, chemists and geneticists led by scientists at the Department of Zoology, University of Delhi has resulted in the development of a novel rifamycin derivative; 24-desmethylrifampicin, which is highly effective against multi-drug resistant (MDR) strains of Mycobacterium tuberculosis. The production of rifamycin analogue was facilitated by genetic-synthetic strategies that have opened an interdisciplinary route for the development of more such rifamycin analogues aiming at a better therapeutic potential. The results of this painstaking effort of nearly 25 years of a team of students and scientists led by Professor Rup Lal have been recently published in the Journal of Biological Chemistry ( www.jbc.org/content/289/30/21142.long ). This strategy can now find applications for developing newer rifamycin analogues that can be harnessed to overcome the problem of MDR, extensively drug resistant (XDR) and totally drug resistant (TDR) M. tuberculosis.

BACKGROUND Management of vitamin B(12) (cobalamin, Cbl) deficiency in inflammatory bowel disease (IBD) is often not evidenced-based because of uncertainty on whether it causes enough malabsorption to result in clinical disease. This systematic review examines whether IBD predisposes to Cbl deficiency. We provide an approach to the management of abnormal Cbl values in IBD based on current literature and consensus-based guidelines. METHODS An extensive search of the Ovid MEDLINE and EMBASE databases by independent reviewers identified 42 articles with a total of 3732 patients evaluating Cbl deficiency in IBD. RESULTS Crohn's disease without ileal resection, regardless of disease location in the ileum, did not increase the risk for Cbl deficiency. Ileal resections greater than 30 cm were associated with Cbl deficiency in Crohn's disease, whereas those less than 20 cm were not. The effects of 20 to 30 cm resections were inconsistent. Ulcerative colitis did not predispose to deficiency. All studies failed to use confirmatory biomarker testing as stipulated by diagnostic guidelines for Cbl deficiency. CONCLUSIONS This literature does not support an association of Crohn's disease in general, regardless of ileal involvement, with Cbl deficiency. Only ileal resections greater than 20 cm in Crohn's disease predispose to deficiency and warrant treatment. Based on these findings, we suggest a diagnostic and therapeutic algorithm. All findings and recommendations require verification in further studies using confirmatory biomarkers as per diagnostic guidelines for Cbl deficiency. Serum Cbl levels alone are likely insufficient to diagnose deficiency in asymptomatic patients.

Tuberculosis (TB), an infectious air borne disease, is a major health problem worldwide. It is the second most lethal disease, next only to AIDS, globally [1]. Besides this, another growing concern is the development of the Multi Drug Resistant (MDR) forms of tuberculosis which have developed due to partial or incomplete treatment. This form of tuberculosis is resistant to the most important primary drugs; isoniazid and rifampicin. As a result the mortality rates due to MDR-TB appear to increase in leaps and bounds, and this ominous phenomena is generally seen in developing and under developed parts of the world. MDR-TB results either from primary infection or may develop in the course of a patient’s treatment. TB, however, is a curable disease but MDR-TB requires much stronger treatment for up to 2 years, with second line treatment, for which the drugs are limited and are not always available [2]. MDR-TB is highly prevalent in people infected with HIV [3], as a suppressed immune system makes HIV patients more vulnerable to drug resistant TB. India is reported to be highly burdened with TB cases, accounting for 21 % of the global incidence, with an estimated 2 million cases, annually. It is also estimated by the World Health Organization that 320,000 people die from TB each year in India. In January 2012, India became the second country in the world to report a strain of TB that is resistant to all known drugs, a form termed as the Totally Drug Resistant TB (TDR-TB). Despite the loss of millions of lives, TB remains one of the most neglected diseases due to lack of proper treatment. Especially, there is no commercially available drug available to treat MDR-TB yet. In a recent shocking disclosure by WHO, India is home to around 73,000 MDR-TB patients, supposedly the highest numbers in the world. However, only 1,660 cases were notified and 1,136 cases are being treated. The statistics are clear indicators of inappropriate treatment and incoherence of the patients to the treatment regime, which results from lack of awareness. For improving the status of TB, in May 2012, India took a step forward and declared TB to a notifiable disease, where all doctors, caretakers treating a TB patient must report every TB case to the government. In September 2012, guidelines were set on how TB cases are supposed to be notified. Inadequate care and mismanagement are primary reasons for the emergence of this deadly disease. Despite launching new programs, India’s Revised National Tuberculosis Control Program (RNTCP), by the Indian government, addressing the issues of TB along with its resistant forms, default rates in the MDR-TB program remains high. This scenario will continue to spread drug resistant TB among communities and will further amplify resistance. Looking at the current scenario, there is a compelling and urgent need for novel TB drug regimens, effective and safe vaccines to keep the disease under control. Further, launching a more effective TB control programme in India will be a steping stone towards controlling the disease which is becoming deadlier by the day.

Cytological examination of serous effusions helps in staging, prognostication and management of patients with malignancy. The method has disadvantage of lower sensitivity in differentiating reactive atypical mesothelial cells from malignant cells.The aim of this study is to compare the cytological features of pleural and peritoneal exudative fluids by conventional smear (CS) method and cell block (CB) method and also to assess the utility of a combined approach for cytodiagnosis of these effusions.One hundred and fifty-three pleural and peritoneal exudative fluid samples were subjected to evaluation by both CS and CB methods over a period of 2 years. Cellularity, architecture patterns, morphological features and yield for malignancy were compared, using the two methods. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for diagnosing malignancy were calculated by both methods, using histology as a gold standard.CB method provided higher cellularity, better architectural patterns and additional yield for malignancy as compared to CS method (P0.005). Sensitivity, specificity, PPV, NPV, and accuracy by CS method were 69.2%, 95%, 56.25%, 97.08% and 92.8%, while by CB method were 92.30%, 99.2%, 92.30%, 99.28% and 98.6%.The present study shows that it is advisable to routinely make CBs before discarding specimens that are suspicious for malignancy by smear examination.

Background: Indian guidelines recommend routine referral for HIV testing of all tuberculosis (TB) patients in the nine states with the highest HIV prevalence, and selective referral for testing elsewhere. We assessed the clinical impact and costeffectiveness of alternative HIV testing referral strategies among TB patients in India. Methods and Findings: We utilized a computer model of HIV and TB disease to project outcomes for patients with active TB in India. We compared life expectancy, cost, and cost-effectiveness for three HIV testing referral strategies: 1) selective referral for HIV testing of those with increased HIV risk, 2) routine referral of patients in the nine highest HIV prevalence states with selective referral elsewhere (current standard), and 3) routine referral of all patients for HIV testing. TB-related data were from the World Health Organization. HIV prevalence among TB patients was 9.0% in the highest prevalence states, 2.9% in the other states, and 4.9% overall. The selective referral strategy, beginning from age 33.50 years, had a projected discounted life expectancy of 16.88 years and a mean lifetime HIV/TB treatment cost of US$100. The current standard increased mean life expectancy to 16.90 years with additional per-person cost of US$10; the incremental costeffectiveness ratio was US$650/year of life saved (YLS) compared to selective referral. Routine referral of all patients for HIV testing increased life expectancy to 16.91 years, with an incremental cost-effectiveness ratio of US$730/YLS compared to the current standard. For HIV-infected patients cured of TB, receiving antiretroviral therapy increased survival from 4.71 to 13.87 years. Results were most sensitive to the HIV prevalence and the cost of second-line antiretroviral therapy. Conclusions: Referral of all patients with active TB in India for HIV testing will be both effective and cost-effective. While effective implementation of this strategy would require investment, routine, voluntary HIV testing of TB patients in India should be recommended.

Kaposi's sarcoma (KS) is a lymphoangioproliferative neoplasm induced by human herpes virus 8 (HHV-8). Four clinical variants have been recognized: classical, African endemic, AIDS-related, and KS caused by iatrogenic immunosuppression. The latter is typically associated with the use of immunosuppressive therapy in organ transplant recipients; however, iatrogenic KS can also occur in patients receiving immunosuppression for other indications, such as autoimmune disorders.1 Granulomatosis with polyangiitis (GPA), formally known as Wegener's granulomatosis, is a multisystem necrotizing autoimmune vasculitis, which can be fatal and is classically treated with cyclophosphamide (CP) and prednisone.2 To our knowledge, only 3 cases report the development of iatrogenic KS in the context of GPA.3, 4, 5 We describe a case of an HIV-negative patient who had iatrogenic KS after GPA therapy, did not improve after first-line treatment reduction or withdrawal of immunosuppression, and consequently required systemic treatment with liposomal doxorubicin.