Abstract : Emergence of antibiotic resistance is a global concern in this era to combat infectious diseases. Streptococcus pneumoniae is one of the most common causes of community-acquired respiratory tract infections and the drug of choice for treatment was penicillin. However, the first clinically significant penicillin-non-susceptible pneumococcus (PNSP) was documented in 1967. Since then, penicillin resistance strain had been identified in different continents of the world. Among 94 serotypes of S. pneumoniae, “paediatric serotypes” (6A, 6B, 9V, 14, 15A, 19A, 19F and 23F) were found to have the highest resistance to penicillin and erythromycin globally. The mechanism of penicillin resistance in S. pneumoniae is conveyed by the alternation of the structure of penicillin binding proteins (PBPs), which leads to reducing the affinity for penicillin. There is a relationship between antibiotic consumption and dissemination of antibiotic resistant pneumococcal clones in Southern and Eastern Europe, America, and Asia. Therefore, rational use of antibiotics is important in order to decrease the development and spread of resistant strains. After the introduction of Pneumococcal conjugate vaccine (PCV) 7 vaccine, non-vaccine serotypes like 6C, 11A, 15A, and 15B/C have increased in prevalence. Since the changes in serotype prevalence due to selective pressure have been observed, it is necessary to monitor the prevalent serotypes. Optimal coverage may be achieved by using vaccines with a wide range of serotype coverage in the future. In managing pneumococcal infections, sensitivity tests are important to choose the appropriate antibiotics. In severe pneumonia or hospital-acquired pneumonia patients at the area of high prevalence of PNSP, the initial antibiotics must include intravenous carbapenems, ceftriaxone, cefotaxime or newer quinolones, meanwhile, penicillin-resistant pneumococcal meningitis (≥ 2 µg/ml) is vancomycin and ceftriaxone or cefotaxime. Judicious use of antibiotics, modification of the treatment duration and encouragement for adherence by patients are recommended to prevent antibiotic resistance. Development of new classes of drugs and novel therapeutic regimen is essential to overcome the hazard of penicillin resistance pneumococcal infection in future.

Keyword : Penicillin resistance, β-Lactams, Streptococcus pneumoniae, Community-acquired respiratory tract infections.

Abstract : Caralluma fimbriata (Asclepiadaceae) grows wild all over India and is a traditional food plant. It is well known as a famine food, appetite suppressant and thirst quencher. The current investigation was designed to evaluate memory enhancing activity of aqueous and ethanol extracts of Caralluma fimbriata by using Cookʾpole climbing apparatus and estimation of acetyl cholinesterase inhibitory activity. Scopolamine butyl bromide (1mg/kg bw, i.p) were administrated to animals thirty minutes before foot shock to produce amnesia. Animals were trained to leap on the pole to avoid electrical shock. They received 200 and 400 mg/kg dose of aqueous and ethanol extracts of Caralluma fimbriata orally one hour before the induction of foot shock daily. Acetyl cholinesterase activity was appraised by supplying an acetyl thiocholine as substrate which cause to release thiocholine as consequence of cleaving by acetyl cholinesterase. Thiocholine reduced Ellman reagent to thionitrobenzoic acid as yellow product which could absorb light at 412 nm. The groups treated with aqueous and ethanol extracts of Caralluma fimbriata were exhibited to enhance memory by restored mean percentage of conditional avoidance response towards normal. Acetyl cholinesterase inhibitory activities of extracts of Caralluma fimbriata were found to have the supportive memory enhancing activity by magnifying the cognitive function.

Keyword : Keywords: Caralluma fimbriata, memory enhancing activity, cookʾpole climbing apparatus

Abstract : Introduction: Community-acquired pneumonia (CAP) is a common disease with frequent hospitalization and still high mortality rate. Aim: To analyze the clinical characteristics of patients who died in the hospital from CAP. Materials and Methods: 1292 patients hospitalized in the Clinic of Pneumonology and Phthisiatrics of MHAT “Saint Marina” – Varna were retrospectively studied for the period 2012 to 2015. Data were analyzed with statistical program SPSS.20. Results: 148 patients (11.5%) died during the hospital stay. The non-survivors were significantly older than the survivors (67.6±14.2 vs. 58.9±17.1 years, p<0.001). No significant difference in the mortality rate between male and female was proven (12.3 % vs. 10.3 %, р=0.15). Charlson comorbidity index was significantly higher in non-survivors compared to survivors (3.28±2.21 vs. 1.36±1.63, p<0.001). Patients with dementia, carcinoma with metastases and cerebrovascular disease as concomitant comorbidities had the highest risk of dying in the hospital (OR 6.86 (3.97-11.84); 4.33 (1.43-13.12); 4.05 (2.77-5.92) resp. p<0.05) C-reactive protein was also significantly higher in non-survivors compared to survivors (171.85±83.17mg/L vs.123.42±99.68mg/L, р<0.001). The most common complication was acute respiratory failure (89.9%). Of the deceased patients 16.9% did not meet the criteria for severe CAP according to IDSA/ATS on admission. Most of the deceased patients (52%) died within the first 3 days of the hospital stay. Conclusion: Older patients with comorbidities had higher risk of dying in the hospital. Patients with CAP need intensified monitoring especially in the first 3 days even if they do not have severe pneumonia on admission.

Keyword : Community-acquired pneumonia, severity, mortality

Abstract : Two distinct schools of thought and two men have continued to dominate psychiatry over the past century. Despite both of these men supporting eugenics; Emil Kraepelin and Paul Eugen Bleuler also held very different views on how better outcomes could best be achieved. Progress in the delivery of better outcomes for schizophrenia has halted. Gaining an understanding of the neurobiology involved in schizophrenia may facilitate the delivery of better clinical outcomes. An extensive narrative review of the literature was undertaken to ascertain a neurobiological basis for schizophrenia. This review revealed a metabolic disorder that produces an adaptation to chronic nutrient or hypoxic stress. The formation of a stress memory will be explored. An evidence base will be presented to support rationale for relabeling psychiatric disorders as a stress memory with prominent symptoms. For instance, psychosis, mood disturbance, persistently low mood, anxiety or a delayed reaction in the case of post-traumatic stress disorder. Besides the argument for neurobiological and symptom accuracy, an appropriate name change may be prudent to reduce the burden of stigma that was derived from the eugenics movement and which continues to defame people today.

Keyword : schizophrenia, post-traumatic stress disorder, bipolar disorder, depression, anxiety