Clinicomycological overview of brain abscess in a tertiary care center: A 38 year retrospection: Fungal brain abscess.

INTRODUCTION: Brain abscesses (BA) form approximately 8% of intracranial masses in developing and 1-2% in western countries. Fungal BA (FBA) are aggressive and represent a catastrophic manifestation compared to protozoan and bacterial BA. Diagnosis of FBA is rare and usually done postmortem. OBJECTIVES: The present retrospective study analyses the clinico-mycological aspects of FBA presented to our neurosurgical services over a period of 38 years, from January 1979 to April 2017. MATERIALS AND METHODS: Patients diagnosed as definitive cases of FBA were included in the study. Clinico- demographic and microbiological data were collected from medical records. BA pus was examined for fungal etiology using standard microbiological procedures. RESULTS: During the period of 38 years out of total 2,916 brain abscesses, 29 cases of FBA were diagnosed with an overall incidence rate of 0.99% per year. Cladophialophora bantiana (44%) was the most predominant isolate followed by Aspergillus spp and others. Male preponderance was seen with a male:female ratio of 4.8:1. There was no predilection for any age group. Headache, limb weakness and fever were the most common presentations. Amphotericin B was given in 44.8% of cases. Craniotomy with excision (48.2%) was the predominant surgical management. Outcome was fatal in 62% of the cases. CONCLUSION: Neurotropic C. bantiana is the predominant isolate causing fungal brain abscess. The incidence and trends of fungi causing brain abscess do not show significant change. Young immunocompetent outdoor working males were predominantly susceptible to fungal infection. Advance in the diagnostic modalities show promising in diagnosis of FBA. High index of suspicion with early diagnosis, prompt antifungal therapy and aggressive surgical management is required as FBA are associated with high mortality rate.

Biosynthesis of CMC-Guar gum-Ag0 nanocomposites for inactivation of food pathogenic microbes and its effect on the shelf life of strawberries.

A few fruits have short post-harvest life due to high metabolic activity, relatively high water content vulnerability towards microbes and loss of weight during their storage. Carboxymethyl cellulose (CMC)-Guar gum-silver nanocomposite films (CG-Ag0NC) are developed to address these issues. The silver nanoparticles were generated in the CMC-Guar gum matrix through a reduction by Mentha leaves extract. All the films were characterized by UV-vis spectroscopy, FT-IR, TGA, XRD, SEM, TEM, and zeta potential measurements. The antimicrobial activity of CG and CG-Ag0NC was measured by determining their zone inhibition values with ten food pathogenic microbes. The shelf life of CG-Ag0NC films was tested with the model fruit, strawberries, and compared with other packing films. The results are encouraging in terms of freshness, shelf-life and weight loss.

A study on the glycemic, lipid and blood pressure control of type 2 diabetes patients of Kerala.

AIM: Aim of the study was to detect the level of comprehensive diabetes control among the diabetic patients of Kerala, India. METHOD: Patients (1200) were randomly selected from a diabetes care center. Their blood sugar and other biochemical and anthropometric measurements were done and statistically analyzed. RESULT: Only 28.3% had their A1C at or below 7% and 45% above 9%. 1/3rd of the female and 1/5th of the male patients had CAD. The prevalence of hypertension was almost equal in both sexes. However, there was a statistically significant higher systolic BP (mean 162.12mm Hg vs 147.49mm Hg, p=0.01044) among females. The total Cholesterol was above 200mg/dl in 42.1% of males and 45.61% of females. The triglyceride was >150mg/dl in 38.6% males and 50.88% females. Low HDL cholesterol levels were found in 20.07% of males and 41.12% of females (p=0.0445). The mean LDL was 121.75 (±32.29247) DISCUSSION: The mean blood sugar values are found to be high which will lead to a predictable increase in vascular disease, which in turn will affect the quality of health and productivity of the individual and the economic growth of the society as a whole. Studies suggest that therapeutic interventions to improve glycemic control may reduce the risk of CVD and microvascular disease. CONCLUSION: This study shows that the level of diabetes control in Kerala is unsatisfactory. We need more medications, better strategies, and more emphasis on glycemic management than we are currently able to apply.

Posterior reversible encephalopathy syndrome in pediatric acute leukemia: Case series and literature review.

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state coupled with a unique radio imaging appearance. We describe this rare, mostly reversible condition in five cases undergoing similar treatment under preset protocol (MCP-841) for acute lymphoblastic leukemia (ALL) at our centre. Hypertension is a well-known adverse effect of high-dose corticosteroid therapy primarily mediated by its effects on the mineralocorticoid receptor especially in pediatric population and we hypothesize that this may be the etiology of PRES in two of these patients.