Antimicrobial Resistance Profile in ICU Patients Across India: A Multicenter, Retrospective, Observational Study.

Background The pattern of antimicrobial resistance (AMR) changes with time and varies in countries and between hospitals within the same country. Physicians might thus benefit from information on regional resistance patterns of clinically significant bacterial isolates when deciding on the best empirical treatment. Numerous nosocomial infections are caused by multidrug-resistant (MDR) strains, notably methicillin-resistant Staphylococcus aureus (MRSA) strains, which are also linked to higher morbidity and death. Aim Evaluation of AMR profile in intensive care unit (ICU) patients of multiple tertiary care centers across India. Methods This was a multicenter, retrospective study based on electronic laboratory records of microbial isolates from clinical specimens from ICUs analyzed at microbiology laboratories of identified hospitals. Data of invasive sample records was collected from Microbiology labs of the identified hospitals within India and were aligned to WHO 5 Net standard reporting and as per Clinical & Laboratory Standards Institute (CLSI-2014) Guidelines for assessment. Data from 21556 samples were collected retrospectively from December 2021 to January 2010. Antibiotic susceptibility testing was done by using both the Kirby Baur disk diffusion method and the automated method (using the Vitek 2 compact system) as per CLSI (2014) guidelines. Results Of 21,556 enrolled patients, the majority (54.12%) were males and adults (62.07%). The median age was 58 years. Of 815 gram-positive bacteria reports, the commonest were S. aureus (552, 67.73%), Coagulase-negative Staphylococci (107, 13.13%), and Enterococcus spp. (105, 12.88%). For Coagulase-negative Staphylococci-positive samples, resistance was to penicillin (79, 73.83%), and erythromycin (73, 68.22%); and for S. aureus was to ciprofloxacin (361, 65.4%), and erythromycin (315,57.07%). Enterococcus spp. showed maximum resistance to erythromycin (73, 69.52%), followed by ampicillin, ciprofloxacin (68,64.76% each). Of 4,183 gram-negative bacteria reports, the commonest were Klebsiella pneumoniae (1,531, 36.6%), Escherichia coli (1,269, 30.34%), and Acinetobacter spp. (589, 14.08%), Pseudomonas aeruginosa (438, 14.08%), other Klebsiella spp. (174, 4.16%) and Enterobacter spp. (161, 3.85%). K. pneumoniae showed resistance to ciprofloxacin (1,001, 65.38%). E. coli showed resistance to ampicillin (918, 72.34%), and ciprofloxacin (798,62.88%); and Acinetobacter spp. to ceftazidime (525, 89.13%), and ciprofloxacin (507, 86.08%), while P. aeruginosa showed resistance to imipenem (234, 53.42%). Enterobacter spp. showed resistance to cefotaxime (129, 80.12%). MRSA samples showed resistance to phenoxymethylpenicillin (188, 35.54%) and benzylpenicillin (178, 33.46%). Conclusion Gram-negative bacteria were more common than gram-positive bacteria in causing antibiotic-resistant infections in ICU, with beta-lactams, fluoroquinolones, macrolides, and cephalosporins showing varied percentages of resistance. Fluoroquinolones, macrolides, and penicillin were noted to be highly resistant against gram-positive species. This indicates that evaluation based on MDR and antibiotic consumption patterns is imperative.

Manipulating ultrafast magnetization dynamics of ferromagnets using the odd-even layer dependence of two-dimensional transition metal di-chalcogenides.

Two-dimensional transition metal dichalcogenides (TMDs) have drawn immense interest due to their strong spin-orbit coupling and unique layer number dependence in response to spin-valley coupling. This leads to the possibility of controlling the spin degree of freedom of the ferromagnet (FM) in thin film heterostructures and may prove to be of interest for next-generation spin-based devices. Here, we experimentally demonstrate the odd-even layer dependence of WS2 nanolayers by measurements of the ultrafast magnetization dynamics in WS2/Co3FeB thin film heterostructures by using time-resolved Kerr magnetometry. The fluence (photon energy per unit area) dependent magnetic damping (α) reveals the existence of broken symmetry and the dominance of inter- and intraband scattering for odd and even layers of WS2, respectively. The higher demagnetization time, τm, in 3 and 5 layers of WS2 is indicative of the interaction between spin-orbit and spin-valley coupling due to the broken symmetry. The lower τm in even layers as compared to the bare FM layer suggests the presence of a spin transport. By correlating τm and α, we pinpointed the dominant mechanisms of ultrafast demagnetization. The mechanism changes from spin transport to spin-flip scattering for even layers of WS2 with increasing fluence. A fundamental understanding of the two-dimensional material and its odd-even layer dependence at ultrashort timescales provides valuable information for designing next-generation spin-based devices.

Cytomegalovirus (CMV) as a cause of exacerbation of ulcerative colitis (UC). An approach to diagnosis and management.

Cytomegalovirus (CMV) reactivation may be a cause of acute exacerbations in patients with severe ulcerative colitis (UC). Patients with exacerbation of symptoms by CMV have greater morbidity and mortality rate. The present study was conducted to evaluate the prevalence of CMV infection in UC patients by endoscopic examination, histopathological examination and CMV DNA PCR of colonic mucosal biopsy tissue and also to identify the associated risk factors and clinical outcomes.

Paratracheal abscess by plant fungus Chondrostereum purpureum- first case report of human infection.

Chondrostereum purpureum, is a plant fungus causing silver leaf disease of plants, particularly of the rose family. Here we report a case of paratracheal abscess caused by C. purpureum. This is a first of its kind of a case wherein this plant fungus caused disease in a human. Conventional techniques (microscopy and culture) failed to identify the fungus. Only by sequencing, the identity of this unusual pathogen could be revealed. This case highlights the potential of environmental plant fungi to cause disease in humans and stresses the importance of molecular techniques to identify the causative fungal species.

A Case of Pacemaker Associated Aspergillus fumigatus Endocarditis.

The use of cardiovascular implantable electronic devices (CIED) is associated with improved quality of life and decreased fatal outcomes in patients with cardiac dysfunctions. As with all foreign devices that are inserted or implanted in the body, CIED also carries the risk of device-related infections. Infections account for <2% of the complications associated with CIED, and only about 2% of these are secondary to a fungal pathogen. The first case of Aspergillus endocarditis secondary to a transvenous pacing lead was reported in the 1980s, and a limited number of cases have been documented in the literature since then. Aspergillus endocarditis is a highly fatal disease and establishing the diagnosis sufficiently early is challenging. We here report a case of Aspergillus endocarditis secondary to permanent pacemaker insertion which was successfully treated following the establishment of the diagnosis using imaging studies and galactomannan assay.

Screen Printed Copper and Tantalum Modified Potassium Sodium Niobate Thick Films on Platinized Alumina Substrates.

We show how sintering in different atmospheres affects the structural, microstructural, and functional properties of ~30 µm thick films of K0.5Na0.5NbO3 (KNN) modified with 0.38 mol% K5.4Cu1.3Ta10O29 and 1 mol% CuO. The films were screen printed on platinized alumina substrates and sintered at 1100 °C in oxygen or in air with or without the packing powder (PP). The films have a preferential crystallographic orientation of the monoclinic perovskite phase in the [100] and [-101] directions. Sintering in the presence of PP contributes to obtaining phase-pure films, which is not the case for the films sintered without any PP notwithstanding the sintering atmosphere. The latter group is characterized by a slightly finer grain size, from 0.1 µm to ~2 µm, and lower porosity, ~6% compared with ~13%. Using piezoresponse force microscopy (PFM) and electron backscatter diffraction (EBSD) analysis of oxygen-sintered films, we found that the perovskite grains are composed of multiple domains which are preferentially oriented. Thick films sintered in oxygen exhibit a piezoelectric d33 coefficient of 64 pm/V and an effective thickness coupling coefficient kt of 43%, as well as very low mechanical losses of less than 0.5%, making them promising candidates for lead-free piezoelectric energy harvesting applications.

Structural Phase-Dependent Giant Interfacial Spin Transparency in W/CoFeB Thin-Film Heterostructures.

Pure spin current has transformed the research field of conventional spintronics due to its various advantages, including energy efficiency. An efficient mechanism for generation of pure spin current is spin pumping, and high effective spin-mixing conductance (Geff) and interfacial spin transparency (T) are essential for its higher efficiency. By employing the time-resolved magneto-optical Kerr effect technique, we report here a giant value of T in substrate/W (t)/Co20Fe60B20 (d)/SiO2 (2 nm) thin-film heterostructures in the beta-tungsten (ß-W) phase. We extract the spin diffusion length of W and spin-mixing conductance of the W/CoFeB interface from the variation of damping as a function of W and CoFeB thickness. This leads to a value of T = 0.81 ± 0.03 for the ß-W/CoFeB interface. A stark variation of Geff and T with the thickness of the W layer is obtained in accordance with the structural phase transition and resistivity variation of W with its thickness. Effects such as spin memory loss and two-magnon scattering are found to have minor contributions to damping modulation in comparison to the spin pumping effect which is reconfirmed from the unchanged damping constant with the variation of Cu spacer layer thickness inserted between W and CoFeB. The giant interfacial spin transparency and its strong dependence on crystal structures of W will be important for future spin-orbitronic devices based on pure spin current.

Probing Atomistic Behavior To Unravel Dielectric Phenomena in Charge Transfer Cocrystals.

Six new binary charge-transfer (CT) cocrystals have been synthesized by solvent drop-assisted mechanochemical grinding method, and all of them exhibited remarkable color changes during the grinding process. Crystal structure analysis reveals the donor (D) and acceptor (A) molecules have assembled primarily via cofacial π···π stacking interactions displaying mixed D-A-D-A stacked columns. Interestingly these cocrystals exhibited very diverse dielectric response in the presence of an alternating current (ac) external electric field, and their dielectric behavior can be explained from the nature and strength of CT interactions in the cocrystal assembly. Strong CT cocrystals were found to display a rigid supramolecular framework while weakly bound CT complexes allowed its constituent polar molecules to relax and hence the observed rotational dynamics contributed to their dielectric properties. Chemical shift anisotropy parameters, spin-lattice relaxation, and molecular correlation times obtained from 13C solid-state NMR spectroscopy measurements establish the occurrence of molecular dynamics at the atomistic scale in cocrystals, thereby displaying high permittivity. Furthermore, we also propose a strategy directed toward the design of CT cocrystals that allows us to introduce rotational dynamics in noncentrosymmetric molecules, which significantly enhances their dielectric properties due to orientation polarization. The results indicate that D-A-based organic CT systems, particularly with a mixed stack, have a wide range of potential applications in materials science.

Characterization of Gut Microbiome in Liver Transplant Recipients With Nonalcoholic Steatohepatitis.

Nonalcoholic fatty liver disease (NAFLD) and its progressive form nonalcoholic steatohepatitis (NASH) are a growing problem globally and recur even after liver transplant (LT). We aim to characterize the gut dysbiosis in patients who developed recurrent NAFLD compared with patients without recurrence following LT. METHODS: Twenty-one patients who received LT for NASH and had a protocol liver biopsy performed beyond 1-y post-LT were included prospectively (January 2018-December 2018). Genomic DNA extraction, next-generation sequencing, and quantitative PCR analysis were performed on stool samples collected within 1.1 ± 1.6 y from time of liver biopsy. RESULTS: Recurrent NAFLD was noted in 15 of the 21 included patients. Stool microbiome analysis at the genus level showed significant loss of Akkermansia and increasing Fusobacterium associated with NAFLD recurrence. Quantitative PCR analysis revealed significantly decreased relative abundance of Firmicutes in patients with NAFLD activity scores (NASs) ≥5 as compared with patients with lower NAS scores, whereas Bacteroidetes were significantly increased with higher NAS (P < 0.05). Firmicutes (P = 0.007) and Bifidobacterium group (P = 0.037) were inversely correlated, whereas Bacteroidetes (P = 0.001) showed a positive correlation with higher hepatic steatosis content. The Firmicutes/Bacteroidetes ratios were higher in patients without NAFLD or NASH as compared with patients diagnosed with NAFLD or NASH at the time of sample collection. CONCLUSIONS: Akkermansia, Firmicutes, and Bifidobacterium may play protective roles in the development of recurrent NAFLD in LT recipients, whereas Fusobacteria and Bacteroidetes may play pathogenic roles. These findings highlight the potential role of the "gut-liver" axis in the pathogenesis of NAFLD recurrence after LT.

Sphingosine Kinase 2 Phosphorylation of FTY720 is Unnecessary for Prevention of Light-Induced Retinal Damage.

Mammalian Sphingosine kinase 2 is the primary enzyme responsible for phosphorylating FTY720 to its active form, FTY720-P. Systemic FTY720 treatment confers significant protection to murine retinas from light- and disease-mediated photoreceptor cell death. It is not clear whether FTY720-P, FTY720, or both are responsible for this photoreceptor protection. We investigated Sphingosine kinase 2 knockout (Sphk2 KO) mouse retinas, tested their sensitivity to light, and measured what degree of protection from light-induced damage they receive from systemic FTY720 treatment. Sphk2 KO retinas were found to be similar to their wild-type counterparts in sensitivity to light damage. Additionally, FTY720 treatment protected Sphk2 KO retinas from light-induced damage despite significant retardation of FTY720 phosphorylation in Sphk2 KO mice. We conclude that FTY720 serves an active role in preventing photoreceptor cell death. Furthermore, we conclude that the phosphorylation of FTY720 is not necessary to provide this protective effect.

Rough sets: past, present, and future.

Introduction of rough sets by Professor Zdzislaw Pawlak has completed 35 years. The theory has already attracted the attention of many researchers and practitioners, who have contributed essentially to its development, from all over the world. The methods, developed based on rough set theory alone or in combination with other approaches, found applications in many areas. In this article, we outline some selected past and present research directions of rough sets. In particular, we emphasize the importance of searching strategies for relevant approximation spaces as the basic tools in achieving computational building blocks (granules or patterns) required for approximation of complex vague concepts. We also discuss new challenges related to problem solving by intelligent systems (IS) or complex adaptive systems (CAS). The concern is to control problems using interactive granular computing, an extension of the rough set approach, for effective realization of computations realized in IS or CAS. These challenges are important for the development of natural computing too.

Statistical optimization of production conditions of ß-glucosidase from Bacillus stratosphericus strain SG9.

The present study illustrates the optimization and characterization of ß-glucosidase from a bacterial isolate, strain SG9. Sixty-eight different variables were first screened by one factor at a time method. The screened variable optimization was then performed by Plackett-Burman design followed by Box-Behnken response surface methodology. Thirty-one variables were screened, of which five variables were found to be significant. Box-Behnken design was then performed using the most significant variables, viz., esculin, K2HPO4 and MgSO4. The maximum enzyme activity was observed with an optimal medium composition of esculin (1.9 g/L), K2HPO4 (0. 5 g/L) and MgSO4 (0.3 g/L) with a predicted value of 3392.01 IU. The maximum ß-glucosidase production achieved was 3340 IU. The bacterial strain was identified by 16S rRNA gene sequence and biochemical characterization. The strain was identified as Bacillus stratosphericus and is a first report of its kind.

A prospective study of ventilator-associated tracheobronchitis: Incidence and etiology in intensive care unit of a tertiary care hospital.

CONTEXT: Ventilator-associated tracheobronchitis (VAT) is an infective complication of mechanical ventilation and is a part of the spectrum of ventilator-associated respiratory infections. In the Intensive Care Units (ICUs), VAT is a relatively common problem but in comparison to ventilator-associated pneumonia (VAP), much less data are available on VAT and its management. MATERIALS AND METHODS: Patients ventilated for more than 48 hours were screened daily for the development of VAT. Patients were followed up daily until they were extubated, died or discharged from the hospital. The patient demographics, underlying condition, causative organism and resistance patterns were observed. RESULTS: 13.2% of patients developed VAT. The majority patients who developed VAT had underlying neurological problems. The mean time to develop VAT from the time of mechanical ventilation was 7.3 days and from time of ICU admission was 10 days, respectively. Multidrug-resistant (MDR) Acinetobacter sp. and Pseudomonas aeruginosa were the most frequently isolated organisms. CONCLUSIONS: VAT is a common healthcare-associated infection caused mostly by MDR Gram-negative bacteria. Monitoring and active surveillance are required to detect VAT at the earliest to institute appropriate isolation measures and therapy.

Severe dengue due to secondary hemophagocytic lymphohistiocytosis: A case study.

Dengue, transmitted by the mosquito Aedes aegypti affects millions of people worldwide every year. Dengue induced hemophagocytic lymphohistiocytosis (HLH) is a serious condition and may prove fatal if not detected early and treated appropriately. Diagnosis of HLH is challenging and usually missed as clinical and laboratory findings are nonspecific. Moreover, the pathophysiology of the systemic inflammatory response syndrome and/or sepsis is remarkably similar to HLH. Secondary HLH following infection by the dengue virus is now being increasingly recognized as a cause of severe form of the disease. We report a case of dengue associated HLH in an otherwise healthy person who deteriorated during the course of hospitalization. A disproportionately high ferritin level and persistent bicytopenia prompted investigations for HLH. Diagnosis of dengue fever with virus-associated hemophagocytic syndrome was established according to the diagnostic criteria laid down by the Histiocyte Society. We discuss the diagnosis and management of this complex case and try to generate awareness about dengue induced HLH as one of the possible causes for severe manifestations of this infection.

Seven cases of Saccharomyces fungaemia related to use of probiotics.

Probiotics are increasingly used in critically ill patients without enough safety data. The aim of the present study was to determine the association of probiotics with Saccharomyces cerevisiae fungaemia. Seven patients with S. cerevisiae fungaemia were reported at two hospitals in India between July 2014 and September 2015. Detailed clinical history of patients was recorded. Besides the seven patient isolates, three probiotics sachets used in those patients and five unrelated clinical isolates were used for association study by Fluorescent amplified fragment length polymorphism (FAFLP). Antifungal susceptibility testing was performed by broth microdilution technique of CLSI (M27-A3) and interpreted according to CLSI (M27S4). Two patients were premature neonates and five were adults. They were admitted in intensive care unit and were on probiotics containing S. boulardii (except one adult patient). FAFLP analysis showed 96.4-99.7% similarity between blood and corresponding probiotic isolates. Of the three AFLP types (group I, II, II) identified, all the probiotic isolates clustered in group I (major cluster) including majority of the blood isolates. The isolates were susceptible to all antifungal agents tested. Five patients, who could be evaluated, responded promptly to echinocandins or voriconazole. As the prescription of probiotic containing S. boulardii in critically ill patient's leads to the fungaemia, we recommend avoiding this probiotic in those patients.