Extra Precautions Research Articles

October 2016: This Month in JoVE

Here's a look at what's coming up in the October 2016 issue of JoVE: The Journal of Visualized Experiments. In Immunology and Infection, we showcase a series of four videos detailing safety and logistical procedures for working in an Animal Biosafety Level 4, or (A)BSL-4, laboratory. The first of this group, filmed at the NIH Integrated Research Facility at Fort Detrick, demonstrates the safe entry and exit procedures for work inside an (A)BSL-4 suit laboratory suite. Inhalation studies of high-consequence pathogens can simulate natural aerosol transmission, or allow researchers to investigate outcomes of intentional pathogenic aerosol releases. In the second of this series, the authors walk through the safe operation of aerobiology chambers for maximum containment level pathogens, such as the Ebola virus. The challenge of carrying out medical imaging in a high biosafety environment is the focus of the third of these releases. Here, our Authors detail how to prepare animals infected with high-consequence pathogens for noninvasive medical imaging, whilst ensuring that the equipment remains easily accessed and free from contamination. In the final video of this miniseries, we take an in-depth look at the extra precautions and procedures involved in performing viral assays in a Class II biosafety cabinet in a BSL-4 environment. As a whole, these four releases are a valuable library for researchers handling challenging and potentially harmful biological materials. Woody plants and secondary tree stems are key habitats, as well as being of great cultural and commercial importance. Understanding stem growth and wood formation is therefore an important topic for tree production, conservation, and preservation. In JoVE Genetics this month, Spokevicius et al (our Authors) describe a method to create transgenic somatic tissue sectors directly in the living secondary stem of woody plants. This versatile method can facilitate rapid functional characterization of genes of interest, be utilized in a range of tree species, and test multiple genes and promoters at a high throughput level. Arguably one of the most recognizable paintings of all time, the Mona Lisa is famous for the subject's elusive and indefinable expression. In JoVE Behavior, Soranzo and Newbury (our Authors) demonstrate how a similar visual illusion-dubbed the uncatchable smile because of it's tendency to disappear as the observer tries to catch it-was discovered in La Bella Principessa, also by Da Vinci. Using a combination of methods including interobservation, psychophysical experiments, and structured interviews, the authors reveal that the ambiguity in La Bella Principessa's expression is attributed to a visual illusion at the mouth of the subject similar to that observed in the Mona Lisa. You've just had a sneak peek of the October 2016 issue of JoVE. Visit the website to see the full-length articles, plus many more, in JoVE: The Journal of Visualized Experiments.

Voiding dysfunction in patients with nasal congestion treated with pseudoephedrine: a prospective study.

BackgroundPseudoephedrine is a sympathomimetic drug widely used as a nasal decongestant. However, it can cause adverse effects, such as voiding dysfunction. The risk of voiding dysfunction remains uncertain in patients without subjective voiding problems.MethodologyWe prospectively enrolled patients with nasal congestion who required treatment with pseudoephedrine from May to August 2015. All patients denied concomitant subjective voiding problem. The International Prostate Symptom Score (IPSS) questionnaire was used to evaluate voiding function before and 1 week after the pseudoephedrine treatment. The results of the IPSS questionnaire were analyzed as the total (IPSS-T), voiding (IPSS-V), storage (IPSS-S), and quality of life due to urinary symptom scores.ResultsWe enrolled 131 males with a mean age of 42.0±14.3 years. The IPSS-T, IPSS-V, and IPSS-S scores slightly increased after the medication (IPSS-T increased from 6.49 to 6.77, IPSS-V from 3.33 to 3.53, and IPSS-S from 3.17 to 3.24). The quality of life due to urinary symptom score nonsignificantly decreased from 2.02 to 1.87. We observed that older age and a higher premedication IPSS-V score yielded significant differences (P<0.05) for subclinical voiding dysfunction and unchanged voiding function. In patients aged ≥50 years, the IPSS-T, IPSS-V, and IPSS-S scores significantly increased after the pseudoephedrine treatment (IPSS-T increased from 9.95 to 11.45, IPSS-V from 5.38 to 6.07, and IPSS-S 4.57 to 5.38), whereas the quality of life due to urinary symptom score nonsignificantly decreased from 2.71 to 2.48 (P=0.057). In patients aged <50 years, all scores did not significantly differ.ConclusionPseudoephedrine treatment for nasal congestion requires extra precautions in males >50 years, even without subjective voiding symptoms.

Visualising DEM-related flood-map uncertainties using a disparity-distance equation algorithm

Abstract. The apparent absoluteness of information presented by crisp-delineated flood boundaries can lead to misconceptions among planners about the inherent uncertainties associated in generated flood maps. Even maps based on hydraulic modelling using the highest-resolution digital elevation models (DEMs), and calibrated with the most optimal Manning's roughness (n) coefficients, are susceptible to errors when compared to actual flood boundaries, specifically in flat areas. Therefore, the inaccuracies in inundation extents, brought about by the characteristics of the slope perpendicular to the flow direction of the river, have to be accounted for. Instead of using the typical Monte Carlo simulation and probabilistic methods for uncertainty quantification, an empirical-based disparity-distance equation that considers the effects of both the DEM resolution and slope was used to create prediction-uncertainty zones around the resulting inundation extents of a one-dimensional (1-D) hydraulic model. The equation was originally derived for the Eskilstuna River where flood maps, based on DEM data of different resolutions, were evaluated for the slope-disparity relationship. To assess whether the equation is applicable to another river with different characteristics, modelled inundation extents from the Testebo River were utilised and tested with the equation. By using the cross-sectional locations, water surface elevations, and DEM, uncertainty zones around the original inundation boundary line can be produced for different confidences. The results show that (1) the proposed method is useful both for estimating and directly visualising model inaccuracies caused by the combined effects of slope and DEM resolution, and (2) the DEM-related uncertainties alone do not account for the total inaccuracy of the derived flood map. Decision-makers can apply it to already existing flood maps, thereby recapitulating and re-analysing the inundation boundaries and the areas that are uncertain. Hence, more comprehensive flood information can be provided when determining locations where extra precautions are needed. Yet, when applied, users must also be aware that there are other factors that can influence the extent of the delineated flood boundary.

New legal pitfalls surrounding wellness programs and their implications for financial risk

In a 2013 Business Horizons article, we described the serious legal problems that can arise when companies develop corporate wellness programs, and outlined ways in which companies can minimize their financial risk. Recently, the landscape changed: For the first time, the Equal Employment Opportunity Commission asserted that several wellness programs violate the Americans with Disabilities Act. In this installment of Organizational Performance, we explain the battles that are taking place along this new legal front and suggest steps companies can take to best ensure that their financial positions are not undermined by their wellness programs. In particular, we recommend (1) ensuring that wellness programs actually improve employee health; (2) revisiting whether programs are truly voluntary; (3) being cautious about including dependents in wellness programs; (4) collaborating with disabled employees to meet their needs; (5) providing clear, written explanations when asking for medical information; and (6) taking extra precautions to ensure that medical information is confidential.

What are the core ideas behind the Precautionary Principle?

The Precautionary Principle is both celebrated and criticized. It has become an important principle for decision making, but it is also subject to criticism. One problem that is often pointed out with the principle is that is not clear what it actually says and how to use it. I have taken on this problem by performing an analysis of some of the most influential formulations of the principle in an attempt to identify the core ideas behind it, with the purpose of producing a formulation of the principle that is clear and practically applicable.It was found that what is called the Precautionary Principle is not a principle that tells us what do to achieve extra precaution or how to handle situations when extra precaution is called for. Instead, it was found to be a list of circumstances that each justify extra precaution. An analysis of some of the most common and influential formulations of the Precautionary Principle identified four such circumstances: (1) When we deal with important values that tend to be systematically downplayed by traditional decision methods – such as human health and the environment. (2) When we suspect that the decision might lead to irreversible and severe consequences and the values at stake are also irreplaceable, (3) When timing is at least as important as being right. (4) When it is more important to avoid false negatives than false positives.This interpretation of the Precautionary Principle does not say anything about what kind of actions to take when extra precaution is called for, but it does provide a clear and practically useful list of circumstances that call for extra precaution and that is not subject to the most common objections to the Precautionary Principle.

Sharp Truncation of an Electric Field: An Idealized Model that Warrants Caution

In physics, idealized models are often used to simplify complex situations. The motivation of the idealization is to make the real complex system tractable by adopting certain simplifications. In this treatment some unnecessary, negligible aspects are stripped away (so-called Aristotelian idealization), or some deliberate distortions are involved (so-called Galilean idealization). The most important principle in using an idealized model is to make sure that all the neglected aspects do not affect our analysis or result. Point charges, rigid bodies, simple pendulums, frictionless planes, and isolated systems are all frequently used idealized models. However, when they are applied to certain uncommon models, extra precautions should be taken. The possibilities and necessities of adopting the idealizations have to be considered carefully. Sometimes some factors neglected or ignored in the idealization could completely change the result, even make the treatment unphysical and conclusions unscientific.

Stent versus bypass: The reasons and risk factors for early readmission to hospital after myocardial revascularization.

OBJECTIVE:Though 30-day rates of readmission for coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) remain high, readmission rates and associated risk factors have not been well examined. The purpose of the present study was to determine the risk factors for and rates of readmission and to compare two revascularization methods on that basis.METHODS:The study included 2664 consecutive patients who underwent coronary revascularization either with CABG surgery or PCI. The study was performed retrospectively and a wide variety of risk factors related to readmission were selected for analysis, including demographic data, preoperative risk factors and postoperative complications.RESULTS:From the CABG group (Group 1, n=1103), 18.3% were readmitted, as were 15.2% of the PCI group (Group 2, n=1561). In multivariate analysis, age, gender, left ventricular ejection fraction (LVEF), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), length of stay (>10 days), body mass index (BMI), and creatinine level on admission were associated with early readmission for group 1 (Table 3). In group 2, age, gender, LVEF, DM, length of stay (>10 days), and creatinine level on admission were associated with early readmission.CONCLUSION:When two methods of revascularization were compared, rates of readmission were found to be similar. Patients with cited risk factors are prone to readmission in the first 30 days, so extra precautions should be taken at discharge. Neither method can be concluded to be superior with regard to readmission rates.

Dentistry to the rescue of missing children: A review.

Today's society is becoming increasingly unsafe for children: we frequently hear about new incidents of missing children, which lead to emotional trauma for the loved ones and expose systemic failures of law and order. Parents can take extra precautions to ensure the safety of their children by educating them about ways to protect themselves and keep important records of the child such as updated color photographs, fingerprints, deoxyribonucleic acid (DNA) samples, etc., handy. However, in spite of all efforts, the problem of missing children still remains. Developments in the field of dentistry have empowered dentists with various tools and techniques to play a pivotal role in tracing a missing child. One such tool is Toothprints, a patented arch-shaped thermoplastic dental impression wafer developed by Dr. David Tesini, a paediatric dentist from Massachusetts. Toothprints enables a unique identification of the missing children not only through the bite impression but also through salivary DNA. Besides the use of Toothprints, a dentist can assist investigating agencies in identifying the missing children in multiple ways, including postmortem dental profiling, labeled dental fixtures, DNA extraction from teeth, and serial number engraving on the children's teeth. More importantly, all these tools cause minimal inconvenience to the individual, making a dentist's role in tracking a missing child even more significant. Thus, the simple discipline of maintaining timely dental records with the help of their dentists can save potential hassles for the parents in the future.

Glycaemic status in patients of acute myocardial infarction: A detailed analysis

AimsDiabetes mellitus (DM) is considered to be one of the important risk factors for cardiac diseases. Frank diabetes is usually preceded by long term abnormality in glucose homeostasis which is called pre-diabetes. The hypothesis that diabetic patients have greater risk and worse prognosis of Acute Myocardial Infarction (AMI) than pre-diabetics is controversial. Considering that India has been declared as a diabetic capital of the world, the study aimed to assess the load of pre diabetics, diabetics and non-diabetics landing in myocardial infarction. Materials and methodsThe study consisted of through physiological and biochemical evaluation of 200 patients of newly diagnosed AMI and evaluating the load of non-diabetics, pre-diabetics and diabetics among them. ResultIt was found that the total non-diabetic population (normoglycaemic and pre-diabetic) formed the bulk of AMI patient (69%) in our study. The degree of biochemical alterations seen among the three groups suggests that abnormal glucose homeostasis is not the sole determinant of the severity of AMI. The study data also suggests that glycaemic status, which poses a risk for AMI, differs in male and female individuals. Males even with normal glucose level are at increased risk to develop MI. ConclusionThe study concludes that both males and females with their blood glucose in pre-diabetic range are seen to be vulnerable to develop AMI. Thus all individuals irrespective of their glycaemic status around the age of forty should be screened and individuals with fasting sugar in pre-diabetic range should take extra precaution in terms of healthy diet, life style and regular check up

Morally Relevant Similarities and Differences Between Children and Dementia Patients as Research Subjects: Representation in Legal Documents and Ethical Guidelines.

Children and adults with dementia are vulnerable populations. Both groups are also relatively seldom included in biomedical research. However, including them in clinical trials is necessary, since both groups are in need of scientific innovation and new therapies. Their dependence and limited decision-making capacities increase their vulnerability, necessitating extra precautions when including them in clinical trials. Beside these similarities there are also many differences between the groups. The most obvious one is that children have an entire life ahead of them and will become persons with certain ideals and preferences, while adults with dementia have lived a life in which they have expressed their ideals and preferences. Some of the available research guidelines recognize these differences, setting one list of specific requirements for groups of incapacitated adults and another list for children. Other documents, however, do not differentiate and only set requirements for subjects unable to consent as a single category of subjects. In this article we analyse to what extent the similarities and differences between the two groups are represented in legal documents and ethical guidelines. The article presents an overview and an analysis of the requirements for doing research with children and dementia patients. We conclude with suggestions about how to better incorporate the morally relevant aspects of these two groups in legislation and ethical guidelines.

Assessing breast cancer cell lines as tumour models by comparison of mRNA expression profiles.

IntroductionBreast cancer researchers use cell lines to model myriad phenomena ranging from DNA repair to cancer stem cell phenotypes. Though appropriate, and even requisite, for many studies, the suitability of cell lines as tumour models has come into question owing to possibilities of tissue culture artefacts and clonal selection. These issues are compounded by the inability of cancer cells grown in isolation to fully model the in situ tumour environment, which also contains a plethora of non-tumour cell types. It is thus important to understand similarities and differences between cancer cell lines and the tumours that they represent so that the optimal tumour models can be chosen to answer specific research questions.MethodsIn the present study, we compared the RNA-sequencing transcriptomes of a collection of breast cancer cell lines to transcriptomes obtained from hundreds of tumours using The Cancer Genome Atlas. Tumour purity was accounted for by analysis of stromal and immune scores using the ESTIMATE algorithm so that differences likely resulting from non-tumour cells could be accounted for.ResultsWe found the transcriptional characteristics of breast cancer cell lines to mirror those of the tumours. We identified basal and luminal cell lines that are most transcriptionally similar to their respective breast tumours. Our comparison of expression profiles revealed pronounced differences between breast cancer cell lines and tumours, which could largely be attributed to the absence of stromal and immune components in cell culture. A focus on the Wnt pathway revealed the transcriptional downregulation or absence of several secreted Wnt antagonists in culture. Gene set enrichment analysis suggests that cancer cell lines have enhanced proliferation and glycolysis independent of stromal and immune contributions compared with breast cancer cells in situ.ConclusionsThis study demonstrates that many of the differences between breast cancer cell lines and tumours are due to the absence of stromal and immune components in vitro. Hence, extra precautions should be taken when modelling extracellular proteins in vitro. The specific differences discovered emphasize the importance of choosing an appropriate model for each research question.Electronic supplementary materialThe online version of this article (doi:10.1186/s13058-015-0613-0) contains supplementary material, which is available to authorized users.

Sauropus androgynus Leaves for Health Benefits: Hype and the Science

Sauropus androgynus (SA) is a medicinal plant with high antioxidant potential. The leaves of this plant have been traditionally used to treat certain diseases, for weight loss, and as vegetable dishes. SA leaves contain an adequate amount of macronutrients and having most of the micronutrients. The micronutrients are phenolic compounds, carotenoids, antioxidant vitamins, and minerals. SA leaves also contain most of the essential minerals, including sodium, potassium, calcium, phosphorus, iron, magnesium, copper, zinc, manganese, and cobalt. Fresh leaves of SA typically consist of 70%-90% moisture, 3%-8% protein, 1%-4% fat, 1%-2% fiber, and about 2% ash. The other percentage of the leaves is carbohydrate. In this review, the types and amounts of phenolic compounds, carotenoids, antioxidant vitamins, and minerals are presented. Antinutrients and heavy metals detected in SA leaves are also revealed. These compounds could have adverse health effects, such as heavy metal toxicity and induce lung injury. Bronchiolitis obliterans and obstructive ventilatory impairment of the patients are known to be caused by ingestion of uncooked or fresh SA leaves. SA leaves are the staple food in some of the developing nations that provide essential nutrients to the poor people. It also helps to maintain good health of these people. However, fresh consumption and over-consumption of SA leaves are not advisable. It may cause toxicity or lung injury. The antioxidative components of SA leaves have scientifically shown a vast health benefit to the human being, from test tubes to in vivo studies. However, extra precaution should be taken for minimizing the adverse health effect of intake of fresh SA leaves.

Estimating the impact of Mexican drug cartels and drug-related homicides on crime and perceptions of safety

We estimate the impact of drug cartels and drug-related homicides on crime and perceptions of security in Mexico. Since the location where drug cartels operate might be endogenous, we combine the difference-in-difference estimator with instrumental variables. Using surveys on crime victimization we find that people living in areas that experienced drug-related homicides are more likely to take extra security precautions. Yet, these areas are also more likely to experience certain crimes, particularly thefts and extortions. In contrast, these crimes and perceptions of insecurity do not change in areas where cartels operate without leading to drug-related homicides.

Polyethylene Liner Dissociation Is a Complication of the DePuy Pinnacle Cup: A Report of 23 Cases

Polyethylene liner dissociation is a rare but catastrophic event in total hip arthroplasty (THA), and certain implant designs are known to be at greater risk. Although the DePuy Pinnacle (Warsaw, IN, USA) modular acetabular construct has an excellent record of fixation and wear, an unexpectedly high number of liner dissociations has been noted. The purposes of this study were (1) to characterize the clinical parameters observed in a large group of patients who have experienced liner dissociations with the DePuy Pinnacle acetabular component; (2) to describe the radiographic findings in this group of patients; and (3) to calculate a minimum frequency of this complication. Since 2001, 23 patients with previously well-functioning THAs presented with sudden atraumatic polyethylene liner dissociation at four separate institutions. These THAs were performed between 2001 and 2013. Eight different arthroplasty specialists had performed the index hip arthroplasties using the DePuy Pinnacle acetabular component with a polyethylene liner. Polyethylene failures were evaluated for liner type and radiographic cup position. For three of the surgeons who contributed cases, institutional registries allowed the calculation of the number of components of this type that they used during the period in question, which provided a conservative estimate of the frequency of this type of failure. All 23 liner failures occurred atraumatically in previously asymptomatic THAs at a mean of 48 months (range, 3-138 months). Patients characteristically reported a new and sudden onset of discomfort with audible, reproducible squeaking. Surgical inspection of dissociated liners demonstrated displacement of polyethylene with shearing of the peripheral locking tabs. Radiographic evaluation demonstrated that 14 cups were well positioned and nine cups were malpositioned outside the so-called safe zone. Conservative estimates of the frequency of this complication from the three surgeons' practices whose institutional registries allowed calculation of the lowest possible frequency were 0.32% (six of 1888), 0.77% (three of 391), and 0.82% (three of 367). With this report of 23 additional liner dissociations, we suggest that surgeons should be aware of the problem and take extra precautions when using this implant to ensure locking mechanism integrity at the time of surgery. We caution that the frequency of liner dissociation may be higher than previously reported. Level IV, therapeutic study.

Study of tropospheric delay over Indian region from MODIS, NCEP/NCAR data and ground based water vapor measurements at Kolkata

A priori estimation of delays with error variance of atmospheric radio wave propagation is important for precise position estimation and integrity of the system like Global Positioning System (GPS). Tropospheric effects are less severe than the ionospheric counterpart, but behave in a complex manner, making it difficult to isolate them. In this present paper, a ground based radiometer has been utilized to study the characteristics of tropospheric delay and compared it with the MODIS satellite observations over Kolkata (22.57°N, 88.37°E). Results indicate a good agreement between radiometer and MODIS data except the monsoon months. A climatology of spatial and temporal variation of dry and wet tropospheric delay over the Indian subcontinent have also been estimated using MODIS data and NCEP–NCAR reanalysis data for 2008–2012. The spatial variations of dry delay over Indian region are observed to be in the range of 120–250cm with limited seasonal variability. However, the wet delay varies from 20cm in winter months to 45cm during monsoon period in the coastal and central Indian region. Further analysis reveals that the contribution of wet delays in total delay is significant only along the Indo-Gangetic plain. This indicates that extra precaution is needed in handling tropospheric delay for this region due to fast varying nature of water vapor.

Esophagectomy in elderly patients: which is the best prognostic score?

Our study aimed to identify the best prognostic score for fitness for surgery and postoperative morbidity in elderly patients. A prospectively collected database of a consecutive series of patients with esophageal cancer evaluated for possible esophagectomy at our unit was analyzed. Fitness for surgery and postoperative morbidity were used as measures of outcome. The performances of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) score, the Charlson Comorbidity Index, the age-related Charlson Comorbidity Index (ACCI), the American Society of Anesthesiologists scale and the prognostic nutritional index (PNI) were evaluated in elderly patients. Discrimination was measured with receiver operating characteristics curve analysis; calibration was assessed by the Hosmer-Lemeshow goodness-of-fit test. Age did not result a significant predictor for postoperative complications. In elderly patients, ACCI predicted the judgment of the multidisciplinary team about fitness for surgery with the best discrimination (C-index = 0.94). PNI had the best discrimination for postoperative complications (C-index = 0.71) in the elderly group. ACCI best predicted the fitness for surgery in elderly patients. In elderly patients, the most discriminative prognostic score for postoperative complication was PNI, which could be used at admission for surgery to correctly inform patients about their risk and, possibly, to take extra precaution in case of high risk.

A new technique to measure interfacial tension of transformer oil using UV-Vis spectroscopy

Interfacial tension (IFT) and acid numbers of insulating oil are correlated with the number of years that a transformer has been in service and are used as a signal for transformer oil reclamation. Oil sampling for IFT measurement calls for extra precautions due to its high sensitivity to various oil parameters and environmental conditions. The current used technique to measure IFT of transformer oil is relatively expensive, requires an expert to conduct the test and it takes long time since the extraction of oil sample, sending it to external laboratory and getting the results back. This paper introduces a new technique to estimate the IFT of transformer oil using ultraviolet-to-visible (UV-Vis) spectroscopy. UV-Vis spectral response of transformer oil can be measured instantly with relatively cheap equipment, does not need an expert person to conduct the test and has the potential to be implemented online. Results show that there is a good correlation between oil spectral response and its IFT value. Artificial neural network (ANN) approach is proposed to model this correlation.

Dimensional Accuracy of Two-Step Impressions Measured on Scanned Casts in CAD

The purpose of the study was to find out how light-body impression material thickness influences the horizontal dimensional accuracy of casts examined on a scanned model. Customized manikin mandibles were used for impression taking with a dual-phase impression method. These mandibles were prepared in a way that allowed the control of light-bodied impression material thickness. First premolars were prepared for a full crown by supragingival chamfer on both sides in all mandibles. For the measurements, buccal and lingual reference points were made at the preparation margin. Impressions were taken at nine thickness levels and a control level (TTotal = 10; 0-1.2 mm), and the reference points' average distance was compared across thickness levels on both the left and right side. We carried out three measures for each specimen and used three specimens per thickness level. Total sample size was N = 180, creating a sizable database to understand the influence. The results indicated that light-body impression material thickness had no influence on the horizontal dimension of a die measured on scanned dies in these specific circumstances. The thickness of light-body impression material in the dual-phase impression taking technique did not have a significant influence on the horizontal accuracy of scanned dies, which makes the technique safe and reliable for single crown restorations without having to take extra precautions for the thickness of light-body impression material.

Cerebrospinal fluid protein and glucose examinations and tuberculosis: Will laboratory safety regulations force a change of practice?

Cerebrospinal fluid (CSF) protein and glucose examinations are usually performed in chemical pathology departments on autoanalysers. Tuberculosis (TB) is a group 3 biological agent under Directive 2000/54/EC of the European Parliament but in the biochemistry laboratory, no extra precautions are taken in its analysis in possible TB cases. The issue of laboratory practice and safety in the biochemical analyses of CSF specimens, when tuberculosis infection is in question is addressed in the context of ambiguity in the implementation of current national and international health and safety regulations. Additional protective measures for laboratory staff during the analysis of CSF TB samples should force a change in current laboratory practice and become a regulatory issue under ISO 15189. Annual Mantoux skin test or an interferon-γ release assay for TB should be mandatory for relevant staff. This manuscript addresses the issue of biochemistry laboratory practice and safety in the biochemical analyses of CSF specimens when tuberculosis infection is in question in the context of the ambiguity of statutory health and safety regulations.

Identification and Antibiogram Profile of Streptococcus mutans and Streptococcus sobrinus from Dental Caries Subjects

Dental caries is one of the oldest disease in the world and its causative agent is mutans streptococci (MS). Among MS, Streptococcus mutans and Streptococcus sobrinus are implicated in caries active subjects. The objective of this study was to identify and determine the antibiogram profile of S. mutans and S. sobrinus isolates. The dental plaque samples were collected from caries active subjects (aged 35-44 years) and later identified by 16S rDNA sequencing. Out of 65 clinical isolates 36 (55.38%) were S. mutans and 5 (7.69%) were S. sobrinus. Antibiogram profiling was performed to determine the susceptibility of 6 β-Lactam antibiotics (penicillin, ampicillin, cefotaxime, cephalothin, cefazolin and methicillin) and 2 non β-Lactam antibiotics (erythromycin and chloramphenicol) by disc diffusion method. All S. mutans and S. sobrinus isolates were susceptible to the antibiotics employed in this study. Penicillin and ampicillin were the most effective antibiotics against S. mutans and S. sobrinus isolates and no resistance found. The study concludes that all the isolates were susceptible to the antibiotics, and suggests that taking extra precaution while prescribing antibiotics will maintain the bacteria with less resistance. It also recommends to use an alternative prevention, such as a plant extract to avoid upcoming Antibiotic susceptibility testing, Streptococcus mutans, Streptococcus sobrinus, Dental caries, MSB Agar, 16S rDNA sequnencing.