The Role of Chromogenic Replica System for Isolation & Identification of Uropathogens in the Era of Molecular Diagnostics | Chapter 03 | New Insights into Disease and Pathogen Research Vol. 1

Multidrug resistance in uropathogens is a serious problem in a health care set up. To deal with that, rapid identification of the etiological agent from clinical urine sample is utmost important. Use of replica disc for presumptive identification of uropathogens is an easy to perform, cost effective and rapid method, which can be, adopted in the microbiology laboratories as a primary screening method.

Author(s) Details

Dr. Seema Bose

Department of Microbiology, Hind Institute of Medical Sciences, Safedabad, Lucknow, India.

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Delirious Mania: Recognition and Successful Treatment with Donepezil in the Context of Historical and Contemporary Investigations of Delirium and Delirious Mania | Chapter 02 | New Insights into Disease and Pathogen Research Vol. 1

Aims: Presentation of a case of severe delirious mania with resolution of delirium after treatment with donepezil.

Presentation of Case: KA was a 44 y/o Australian female with a history of bipolar affective disorder with psychotic manic episodes. Two weeks prior to her psychiatric admission she was admitted to a medical ward after an overdose (OD) of acetaminophen. On review, it appeared that this OD may have been the beginning of an unrecognized delirious mania. The patient was sent home and returned 2 weeks later for a prolonged psychiatric admission with multiple medical comorbidities. Psychiatric management and medical care were provided in intensive settings and despite adequate treatment and improvement in mood symptoms, her delirium did not resolve. Immediately upon institution of donepezil, her delirium resolved. After a period of stability, donepezil was stopped. Her delirium returned and donepezil was reinstituted with resolution of normal cognitive function.

Discussion: The DSM 5 criteria for Delirium and some inherent difficulties using these criteria are discussed. A review of the literature of delirious mania is presented which shows unresolved controversies but an evolving recognition of this disorder. A Cochrane Review shows no benefit in the use of acetylcholinesterases in the treatment of delirium. However, the multiple etiologies and pathological processes involved in delirium may require unique and individual recognition and management.

Conclusion: This case suggests that the use of donepezil is strongly recommended in the treatment of delirious mania.  Further study is required to clarify in this challenging disorder.

Author(s) Details

Dr. Laurie Jo Moore

Cairns Base Hospital, Mental Health Unit, Cairns, Queensland, Australia.

Dr. Mila Goldner-Vukov

Cairns Base Hospital, Mental Health Unit, Cairns, Queensland, Australia.

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Molecular Basis of Pathogenesis of Diabetes Mellitus Type 2- a New Perspective | Chapter 01 | New Insights into Disease and Pathogen Research Vol. 1

Decreased insulin secretion due to beta cell dysfunction of the pancreas and defective utilization of insulin due to insulin resistance / Hyperinsulinemia are two important issues in the pathogenesis of DM2. There are many explanations in the literature to account for these two observed phenomena and their interrelationship. DM2 is believed to occur due to a complex interplay of environmental and Behavioural factors in genetically predisposed persons. Among the theories explaining the pathogenesis of DM2, the viscera- Portal hypothesis, the Ectopic fat hypothesis and the adipose tissue as an endocrinal gland are prominent. Besides, the role played by oxidative stress, metabolic stress, mitochondrial dysfunction, endoplasmic reticulum stress, etc. are also advanced. It is felt that basic to and at the core of all the observed facts, is the shift of energy metabolism from normal glycolysis to B- oxidation of fats. Hence, how B – oxidation prevails over glycolysis is the fundamental issue to be addressed together with its interrelationships with insulin resistance, as to which is the cause and which is the effect. At the molecular level, an attempt to find answers to the above questions is made in this paper.

To this extent, the Randle fatty acid cycle (Substrate competition theory of Randle) is suitably modified and applied to explain the switch of Energy metabolisms in DM2. Defective disulfide bond formation of the insulin receptor which makes it physiologically ineffective, is suggested as the cause of the insulin resistance where as the prevailing molecular mechanisms stress on post-receptor signaling defect. The cause and effect of both are discussed. This line is considered to be a departure from traditional approaches broached above and briefly outlined in this article.

Author(s) Details

Dr. A. S. V. Prasad

Department of Internal Medicine, G.I.T.A.M Dental Collage, Rishikonda, Visakhapatnam, Andhra Pradesh, India.

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