Madras Medical Mission

Celiac disease (CD) is highly prevalent in the wheat eating population of India. While HLA-DQ genotype is the strongest genetic determinant of CD, other genetic factors are likely contribute to genesis of CD. In this case-control study, we determined the frequencies of single nucleotide polymorphisms (SNP) in non-HLA candidate genes that influence the development of CD. DNA obtained from peripheral blood of 376 patients with CD and 736 controls was used for the studies. Fifty-one candidate gene polymorphisms were identified for evaluation. Competitive allele-specific polymerase chain reactions were designed to genotype biallelic SNPs at the selected loci. The genotype and allelotype was determined using KASP genotyping technology in a real-time PCR instrument. Eighteen of the 51 SNPs tested associated strongly with CD. The strongest association was found with the HLA DQ2.5 haplotype. HLA DQ2.2 haplotype and HLA-DQ8 haplotype were also strongly associated with CD. Non-HLA genes that were significantly associated with CD included those associated with T cell receptor signaling and T cell activation - CD247, CD80, CD28, PRKCQ, TNFAIP3, UBASH3 and ARHGAP31; genes involved in inflammatory cell migration – CCR3 and CCR4; those involved in epithelial protection – GATD3, PARK7 and INAVA (C1orf106); and those influencing RNA – DDX6 and PUS10. We concluded that the non-HLA genes associated with CD in this Indian population were mostly those associated with molecules involved in the T cell receptor signaling pathway downstream to HLA-DQ2/8, which lead to immune and subsequent inflammatory activation.

Inguinal bladder herniation is a rare clinical condition, and its association with a vesical calculus within the herniated bladder segment is exceptionally uncommon. We report the case of a 68-year-old man who presented with bilateral inguinal herniae accompanied by hematuria. He was evaluated with urine culture and sensitivity testing, blood investigations, and computed tomography (CT). CT imaging demonstrated a left inguinal hernia containing a portion of the urinary bladder with an associated 2.5 × 1.8 cm vesical calculus. In collaboration with the urology team, the patient underwent bilateral open mesh hernioplasty with vesicolitholapaxy using a holmium:YAG (Ho:YAG) laser. Successful reduction of the herniated bladder segment and complete removal of the calculus were achieved. Early preoperative identification of bladder herniation with an associated stone through imaging played a critical role in surgical planning and helped avoid inadvertent bladder injury during surgery. This case underscores the importance of considering bladder herniation in elderly male patients presenting with inguinal herniae and urinary symptoms, as timely diagnosis and coordinated surgical-urological management can optimize outcomes and reduce perioperative risk.

Abstract Background Inappropriate prescribing of antibiotics in people with nonspecific urinary symptoms is a challenge in low-resource rural areas, where diagnostic limitations worsen antimicrobial resistance. The Bladder Health Score (BHS), a validated clinical tool differentiates true urinary tract infections (UTIs) from asymptomatic bacteriuria, providing a stewardship opportunity. This study evaluated a clinical pharmacist-led intervention to reduce inappropriate antibiotic use in elderly patients of Rural South Indian villages. Methods A prospective study was conducted from July 2024 to March 2025 in two demographically similar villages. One served as the intervention village, where clinical pharmacists implemented the BHS to guide antibiotic decision-making; the other served as the control village, where patients received standard care. Participants included were elderly residents (≥60 years) presenting with urinary symptoms, delirium or altered mental status. In the intervention village, pharmacists implemented BHS assessments (score ≥3 indicating UTI likelihood) and provided real-time antibiotic recommendations to providers. Primary outcome was inappropriateness of antibiotic prescriptions. Secondary outcomes were days of therapy with antibiotics (DOT), empirical-culture concordance and readmissions at 30 days Results Of 462 enrolled patients (intervention: 234; control: 228), the intervention village demonstrated:58% reduction in inappropriate antibiotic prescriptions (OR 0.42, 95% CI 0.29–0.61; *p*< 0.001).Lower mean antibiotic DOT (4.2 vs. 7.1 days; *p*=0.003) with comparable clinical cure rates (93.0% vs. 91.7%).89% positive predictive value of BHS ≥3 for culture-confirmed UTI.87.3% provider acceptance rate of pharmacist recommendations.No significant difference in 30-day readmissions (4.7% vs. 5.2%; *p*=0.78). Conclusion This pharmacist-delivered BHS intervention strongly decreased rural elderly populations' inappropriate antibiotic use, proving to be feasible and clinically safe. The high predictive value of BHS and strong provider acceptance underscore its utility in low-resource settings. By aligning with WHO AMR priorities, this model offers a cost-effective stewardship strategy for regions with diagnostic limitations. Disclosures All Authors: No reported disclosures

Abstract Background Antimicrobial resistance (AMR) is a major public health concern, particularly in low-resource rural settings with limited antimicrobial stewardship. Rural Tamil Nadu represents a critical region to monitor resistance patterns due to major OTC antibiotic misuse This study assessed antibiotic resistance profiles of bacterial isolates from clinical specimens in rural Tamil Nadu, India. Methods A prospective observational study was conducted from October 2024 to February 2025 across three rural primary health centers in Tamil Nadu, India. Clinical specimens (urine, sputum, blood) were processed using standard microbiological methods. Bacterial identification and antibiotic susceptibility testing (Kirby-Bauer disk diffusion) were performed. Resistance trends were stratified by specimen type and organism. Results A total of 952 clinical isolates were recovered from 1,229 specimens. The most common organisms: Escherichia coli (32.7%), Klebsiella pneumoniae (18.4%), Staphylococcus aureus (15.3%), Pseudomonas aeruginosa (11.7%), and Enterococcus spp. (7.2%). • E. coli showed high resistance to ciprofloxacin (78%), co-trimoxazole (64%), and third-generation cephalosporins (ceftriaxone 71%; cefotaxime 68%) with lower resistance to nitrofurantoin (22%) and meropenem (9%). • K. pneumoniae showed resistance to cefotaxime (76%), gentamicin (52%), and amoxicillin-clavulanate (65%); 18% were carbapenem-resistant. • MRSA prevalence was 39% with 100% susceptibility to vancomycin and linezolid. • P. aeruginosa demonstrated multi-drug resistance (resistance to ≥3 classes) in 27% of isolates, retaining susceptibility to amikacin (81%) and piperacillin-tazobactam (74%). • Enterococcus spp. showed 100% linezolid susceptibility with ampicillin (41%) and vancomycin (5%) resistance. Conclusion Alarming resistance rates were observed against first-line antibiotics, including emerging carbapenem resistance in Klebsiella spp. and E. coli (indicative of ESBL/carbapenemase production). MRSA and vancomycin-resistant Enterococcus highlight urgent needs for local stewardship programs. These findings can guide empirical therapy and inform regional antibiotic guidelines to preserve antimicrobial efficacy in resource-limited rural settings. Disclosures All Authors: No reported disclosures

Mushrooms are recognized as functional foods due to their rich composition of proteins, vitamins, minerals, dietary fiber, and bioactive compounds with antioxidant and immunomodulatory properties. However, their high perishability restricts consumption and limits market potential. This study focused on the development of innovative mushroom-based food products including brownies, cookies, soufflé, paniyaram, juice, and popcorn, with the aim of enhancing shelf life, consumer acceptability, and profitability. The products were prepared using standard recipes with mushroom powder as a functional ingredient, and evaluated through sensory analysis, cost–benefit assessment, and consumer preference studies. Results indicated that mushroom cookies received the highest sensory scores across taste, texture, and overall acceptability, while mushroom paniyaram exhibited the maximum benefit–cost ratio due to its low production cost. Mushroom brownies and popcorn also showed good market potential as nutritious snack options. Overall, value addition substantially improved consumer appeal and economic returns, demonstrating that mushroom-based innovative products can serve as sustainable, health-promoting alternatives to conventional foods. Expanding their commercialization could support farmer income, reduce post-harvest losses, and strengthen food and nutritional security. These findings underscore the potential for scaling up mushroom-based value-added products to enhance public health nutrition and rural entrepreneurship.

Covered stent correction for a sinus venosus atrial septal defect (SVASD) was first performed in 2009. This innovative approach was initially viewed as experimental and was reserved for highly selected patients with unusual anatomic variants. In 2016, increasing numbers of procedures began to be performed, and in several centers, it is now offered as a standard of care option alongside surgical repair. However, covered stent correction for SVASD is not recognized by regulatory authorities, and in the minds of many pediatric and adult congenital cardiologists and surgeons, the condition is viewed as treatable only by cardiac surgery with cardiopulmonary bypass. In April 2023, all centers identified from international conferences, publications, and colleague networks to be undertaking covered stent correction for SVASD were invited to participate in a retrospective audit of their procedures. Data were received on 381 patients from 54 units over a 12-year period with 90% of procedures being performed over the past 5 years. Balloon-expandable stents (8 types) were used in the majority; self-expanding stents (4 types) were used in 4.5%. The commonest stent was the 10-zig covered Cheatham Platinum stent in 62% of cases. In 10 procedures, the stent embolized requiring surgical retrieval and repair of the defect, resulting in technically successful implantation in 371 of 381 (97.4%). Major complications (surgical drainage of tamponade, pacemaker implantation, surgery for pulmonary vein occlusion, and late stent removal) occurred in 5 patients (1.3%). Repeat catheterization to correct residual leaks was required in 7 patients (1.8%). Thus, 359 of 381 patients (94.2%) had successful correction without major complications or additional catheter interventions. This article details the exponential uptake of covered stent correction for SVASD during the past 5 years. Cardiopulmonary bypass was avoided in the majority of patients, and major complications were infrequent. Prospective registries with standardized definitions, inclusion criteria, and follow-up and comparative studies with surgery are now required to help support the extension of covered stent correction as an alternative standard-of-care option for patients with an SVASD.

This study evaluated the effects of Garcinia gummi-gutta (L.) N.Robson (GG) on polycystic ovary syndrome (PCO)-induced in rats and its anti-obesity properties. Fifteen Wistar rats were divided into three groups: control, 10 mg/kg Aqueous Extract of Garcinia gummi-gutta (AEGG), and 20 mg/kg AEGG. PCO was induced using Letrozole-oestradiol, confirmed by vaginal smear tests and weight gain. AEGG was screened for phenol (125.66±1.07 µg/mL) and flavonoid (102.66 ± 0.38 µg/ml) content, with its highest concentrations at 20 mg/mL. Pancreatic lipase inhibition showed AEGG’s anti-lipase effect (66.24%) at 100 μg/mL, compared to orlistat (98.7%) at 1 μg/ml. Rats received 20 mg/kg of AEGG demonstrated the highest significant reduction in body weight (203.8 g ±1.45 SD) and serum luteinizing hormone (LH) levels (1.24 mIU/mL) compared to the 10 mg/kg group and control group. Anatomical examination showed a normal uterus and reduced ovarian cysts in both AEGG-treated groups compared to the control. AEGG, particularly at 20 mg/kg, significantly reduced body weight, LH levels, and reproductive anatomy in PCO-induced rats, while demonstrating potential anti-obesity effects despite lower lipolytic activity compared to orlistat. The study suggests that AEGG at 20 mg/kg offers benefits in managing PCO and preventing obesity.