Unrelenting Infection of Implanted Prosthetic Hip Joint by Corynebacterium striatum.

Non-diphtherial Corynebacterial (NDC) species, while previously considered as culture contaminants, are increasingly being implicated in clinical disease and identified as causes of opportunistic infections. In cases where they grow in pure cultures, isolated from a sterile site or repeated isolations from the same patient, NDC may be labeled as clinically significant. We report here a case of non-healing infection of one of the implanted devices in a case of bilateral total hip replacement, caused by multidrug-resistant Corynebacterium striatum. Adherence to infection prevention strategies is essential for the prevention of prosthetic implant infections.

Serum Magnesium Levels During the Ictal and Interictal Phase in Patients of Migraine: A Prospective Observational Study.

Background: Migraine is one of the primary headaches having a global prevalence of 15%. It is characterized by neurovascular dysfunction and recurrent episodes of headache. The hyperexcitability of the cerebral cortex has been recognized as an important factor in the pathogenesis of migraine, and magnesium (Mg) being a regulator of neuronal excitability is thought to participate in migraine pathogenesis. Objectives: To determine the serum levels of Mg in patients of migraine during the attack and in between attacks as compared to healthy controls. Methods: A total of 50 patients of migraine who fulfilled inclusion criteria were enrolled in the study along with the same number of healthy controls. International Classification of Headache Disorders 3rd Edition, 2013 (ICHD-III) criteria was used for the diagnosis of migraine. Results: The mean serum Mg in migraine cases during the interictal phase was lower than healthy controls (1.849 ± 0.135 vs 2.090 ± 0.205, P < 0.001), which was statistically significant. It was also found that mean serum Mg during attacks was significantly lower than in between attacks (1.822 ± 0.149 vs 1.849 ± 0.135, P = 0.003). Serum Mg levels in migraine cases showed an inverse linear relationship with the frequency of attacks. Conclusion: Relatively low serum Mg in migraine cases when compared with healthy controls and inverse relation of serum Mg levels with the frequency of migraine attacks suggests that Mg is significantly involved in mechanisms underlying migraine pathogenesis, which can be explored as a therapeutic option.

Advances in the therapeutic delivery and applications of functionalized Pluronics: A critical review.

Pluronic (PEO-PPO-PEO) block copolymers can form nano-sized micelles with a structure composed of a hydrophobic PPO core and hydrophilic PEO shell layer. Pluronics are U.S. Food and Drug Administration approved polymers, which are widely used for solubilization of drugs and their delivery, gene/therapeutic delivery, diagnostics, and tissue engineering applications due to their non-ionic properties, non-toxicity, micelle forming ability, excellent biocompatibility and biodegradability. Although Pluronics have been employed as drug carrier systems for several decades, numerous issues such as rapid dissolution, shorter residence time in biological media, fast clearance and weak mechanical strength have hindered their efficacy. Pluronics have been functionalized with pH-sensitive, biological-responsive moieties, antibodies, aptamers, folic acid, drugs, different nanoparticles, and photo/thermo-responsive hydrogels. These functionalization strategies enable Pluronics to act as stimuli responsive and targeted drug delivery vehicles. Moreover, Pluronics have emerged in nano-emulsion formulations and have been utilized to improve the properties of cubosomes, dendrimers and nano-sheets, including their biocompatibility and aqueous solubility. Functionalization of Pluronics results in the significant improvement of target specificity, loading capacity, biocompatibility of nanoparticles and stimuli responsive hydrogels for the promising delivery of a range of drugs. Therefore, this review presents an overview of all advancements (from the last 15 years) in functionalized Pluronics, providing a valuable tool for industry and academia in order to optimize their use in drug or therapeutic delivery, in addition to several other biomedical applications.

Sparganosis mimicking a soft-tissue tumor: A diagnostic challenge.

Human sparganosis is a rare but important food borne zoonosis and could be attributed to increased consumption of raw meat of fish, frogs, snakes etc. Sparganosis may involve varied organ systems but subcutaneous sparganosis remains the one of the commonly reported clinical condition. Rarity of this problem reinforces the necessity of sensitising the treating physicians of the differential possibility of this infection in patients with history of practice of consuming raw meat. Expansion of health communication and provision of safe food and water by the civic agencies can be a part of powerful preventive strategies.

The Changing Pattern of the Quantum of Biomedical Waste Generated from a Tertiary Care Hospital in Delhi.

Background As a consequence of growth and advancement in health care, production of health care waste has seen an exponential upward trend. Waste from individual health care facilities can vary based on the nature and scope of health care services they provide. Objectives To analyze the amount of biomedical waste generated by a tertiary care hospital. Methods Biomedical waste generated by the hospital from 2005 to 2019 was quantified and analyzed to calculate the total amount of incinerable waste, recyclable plastic waste, and sharp and glass waste. The amount of waste generated per bed per day and the compound annual growth rate (CAGR) were also calculated. Results The total amount of biomedical waste generated in 2005 was 65,658 kg, which has substantially increased to 374,712 kg in 2019, with a CAGR of 12.5%. The hospital was producing average biomedical waste of 0.179 kg/bed/day in 2005, which has increased four times in 2019 to reach 0.709 kg/bed/day. The overall estimated plastic waste was 31% of the total biomedical waste in 2005 and 53% in 2019. Conclusion The generation of biomedical waste is likely to see significant upward trends unless diligent deliberations are held between different stakeholders in regard to the reintroduction of reusable materials and waste reduction strategies.

Impact of Aromatic Counter-Ions Charge Delocalization on the Micellization Behavior of Surface-Active Ionic Liquids.

The nature of counter-ions governs the micellar and structural characteristics of surface-active ionic liquids (SAILs). Especially, the introduction of aromatic counter-ions significantly increases their surface adsorption and induces the formation of various types of aggregates like prolate ellipsoidal micelles, rodlike micelles, vesicles, lamellars, etc. The present study reports the role of charge delocalization of two different aromatic counter-ions in the micellization behavior of their respective SAILs in aqueous medium. For this purpose, we have synthesized two SAILs, namely, 1-tetradecyl-3-methylimidzolium phenolate [C14mim][PO] and 1-tetradecyl-3-methylimidzolium benzoate [C14mim][BZ]. The O-atom of phenolate (PO-) possesses negative charge, which is delocalized on its phenyl ring. Conversely, the negative charge of benzoate (BZ-) is not delocalized on its phenyl ring. The more hydrophobic BZ- counter-ion increases the hydrophobic interactions and reduces the electrostatic repulsions more efficiently as compared to PO-, which results in a lower critical micelle concentration (cmc) of [C14mim][BZ] than that of [C14mim][PO]. Interfacial properties obtained by tensiometry reveal better surface activity and absorption efficiency of [C14mim][BZ] as compared to [C14mim][PO]. The increase of cmc and degree of counter-ion binding (ß) with the rise of temperature for both SAILs has been observed by conductometry. The decrease in the polarity of pyrene microenvironment explains the higher compactness of [C14mim][BZ] aggregates than that of [C14mim][PO], observed by fluorimetry. The position of PO- and BZ- is in the stern and palisade layers of C14mim+ aggregates, respectively, located by 1H NMR. The existence of prolate ellipsoidal micelles for both SAILs has been established by small-angle neutron scattering measurements. Thus, the interfacial and bulk properties of [C14mim][PO] lie somewhere in between those of the SAILs having perfect aromatic counter-ions, [C14mim][BZ], and the SAILs having regular inorganic counter-ions like Cl-, Br-, etc.

Temperature-Dependent Solubilization of the Hydrophobic Antiepileptic Drug Lamotrigine in Different Pluronic Micelles-A Spectroscopic, Heat Transfer Method, Small-Angle Neutron Scattering, Dynamic Light Scattering, and in Vitro Release Study.

Pluronics (tri-block copolymers) have a significant role in the pharmaceutical industry and are being used to enhance the solubility and delivery of hydrophobic drugs in different marketed formulations. However, instability and unsatisfactory drug-loading capacity are the major weak spots of these pluronic micelles. The present research work is designed to solve the existing issues by the solubilization study of hydrophobic drugs in different pluronic micelles at variable temperatures. The solubilization of the hydrophobic antiepileptic drug lamotrigine (LAM) in five different pluronic micelles viz. P84, P85, F127, F108, and F68 was studied at different temperatures, 37, 47, and 57 °C, using UV-visible spectroscopy. The solubilization of LAM in pluronic micelles increased with the increase in temperature. Small-angle neutron scattering (SANS) measurements were used to observe the morphological and structural changes taking place in pluronics by increasing the temperature. The SANS results showed the morphological changes of spherical P84 micelles to prolate ellipsoidal micelles at 57 °C due to remarkable increase in the aggregation number. This morphological conversion was further confirmed by the heat transfer method (HTM) and dynamic light scattering (DLS) measurements. DLS measurements confirmed that LAM-loaded micelles showed a greater hydrodynamic diameter (D h) compared to unloaded micelles, assuring LAM solubilization in the pluronic micelles. The rate of controlled release of LAM from five different pluronic micelles was accessed by using different kinetic models to evaluate the in vitro release profile. This is the first report in which HTM measurements are established for the analysis of morphological changes in the thermoresponsive pluronic micelles in real time. The present work corroborates how we can control the drug-loading capacity, morphological structure of the drug carrier, as well as drug release by simply changing the temperature of pluronic micellar media.

Spectrum of neurological complications in chikungunya fever: experience at a tertiary care centre and review of literature.

Chikungunya (CHIK) has re-emerged as a potential neurotropic virus, with outbreaks recently being reported from many parts of India. The present study was conducted to study the spectrum and outcome of neurological complications in patients of CHIK during the 2016 outbreak in Delhi. A total of 42 cases seropositive for IgM CHIK antibodies by MAC-ELISA and developing neurological complications were enrolled. The male:female ratio was 1:2 (age range = 18-90 years). The neurological manifestations observed were encephalitis (n = 12), bulbar palsy (n = 3), acute disseminated encephalomyelitis (n = 1), cerebellitis (n = 1), myelopathy (n = 1), radiculoneuropathy (n = 3), carpal tunnel syndrome (n = 9) and tremors (n = 1). Ten patients reported worsening of pre-existing neuropathic symptoms of diabetic peripheral neuropathy (n = 4) and carpal tunnel syndrome (n = 6). One patient had aggravation of myasthenia gravis leading to respiratory failure. The majority of patients (n = 32) showed a good outcome; ten had a poor prognosis, out of which four died, all from the encephalitis group, particularly the elderly with co-morbidities.

Sodium deoxycholate mediated enhanced solubilization and stability of hydrophobic drug Clozapine in pluronic micelles.

In this report, the solubilization behaviour of a hydrophobic drug Clozapine (CLZ) in micellar suspensions of pluronics having different hydrophilic lipophilic balance (HLB) ratios viz. P84, F127 and F108 in the absence and presence of bile salt sodium deoxycholate (SDC) has been studied. UV-Vis spectroscopy has been exploited to determine the solubilization capacity of the investigated micellar systems in terms of drug loading efficiency, average number of drug molecules solubilized per micelle (ns), partition coefficient (P) and standard free energy of solubilization (∆G°). The morphological and structural changes taking place in pluronics in different concentration regimes of SDC and with the addition of drug CLZ has been explored using dynamic light scattering (DLS) and small angle neutron scattering (SANS) measurements. The SANS results revealed that aggregation behaviour of pluronic-SDC mixed micelles gets improved in the presence of drug. The micropolarity measurements have been performed to shed light on the locus of solubilization of the drug in pure and mixed micellar systems. The compatibility between CLZ and drug carriers (pluronics and SDC) was confirmed using powder X-ray diffraction (PXRD) and Fourier transform infrared spectroscopy (FTIR) techniques. Among the investigated systems, P84-SDC mixed system was found to be highly efficient for CLZ loading. The long term stability data indicated that CLZ loaded P84-SDC mixed micellar formulation remained stable for 3months at room temperature. Further, it was revealed that the CLZ loaded P84-SDC mixed micelles are converted into CLZ loaded pure P84 micelles at 30-fold dilutions which remain stable up to 48-fold dilutions. The results from the present studies suggest that P84-SDC mixed micelles can serve as suitable delivery vehicles for hydrophobic drug CLZ.

An azine based sensor for selective detection of Cu2+ ions and its copper complex for sensing of phosphate ions in physiological conditions and in living cells.

A simple and cost effective unsymmetrical azine based Schiff base, 5-diethylamino-2-[(2-hydroxy-benzylidene)hydrazonomethyl]-phenol (1) was synthesized which selectively detect Cu2+ ions in the presence of other competitive ions through "naked eye" in physiological conditions (EtOH-buffer (1:1, v/v, HEPES 10mM, pH=7.4)). The presence of Cu2+ induce color change from light yellow green to yellow with the appearance of a new band at 450nm in UV-Vis spectra of Schiff base 1. The fluorescence of Schiff base 1 (10µM) was quenched completely in the presence of 2.7 equiv. of Cu2+ ions. Sub-micromolar limit of detection (LOD=3.4×10-7M), efficient Stern-Volmer quenching constant (KSV=1.8×105Lmol-1) and strong binding constant (log Kb=5.92) has been determined with the help of fluorescence titration profile. Further, 1-Cu2+ complex was employed for the detection of phosphate ions (PO43-, HPO42- and H2PO4-) at micromolar concentrations in EtOH-buffer of pH7.4 based on fluorescence recovery due to the binding of Cu2+ with phosphate ions. Solubility at low concentration in aqueous medium, longer excitation (406nm) and emission wavelength (537nm), and biocompatibility of Schiff base 1 formulates its use in live cell imaging.

Advances in the synthesis, molecular architectures and potential applications of gemini surfactants.

Gemini surfactants have been the subject of intensive scrutiny by virtue of their unique combination of physical and chemical properties and being used in ordinary household objects to multifarious industrial processes. In this review, we summarize the recent developments of gemini surfactants, highlighting the classification of gemini surfactants based on the variation in headgroup polarity, flexibility/rigidity of spacer, hydrophobic alkyl chain and counterion along with potential applications of gemini surfactants, depicting the truly remarkable journey of gemini surfactants that has just come of age. We have focused on those objectives which will act as suitable candidates to take the field forward. The preceding information will permit us to estimate the effect of structural variation on the aggregation behavior of gemini surfactants for nanoscience and biological applications like antimicrobial, anti-fungal agent, better gene and drug delivery agent with low cytotoxicity and biodegradability, which makes them more advantageous for a number of technological processes and hence reduces the impact of these gemini surfactants on the environment.

Aggregation and Morphological Aptitude of Drug-Based Ionic Liquids in Aqueous Solution.

Here, we present how replacing the usual inorganic counter ion with a pharmaceutically active aromatic one can greatly affect the interfacial as well as bulk properties of ionic liquids (ILs). We have synthesized a series of novel drug-based ILs, namely, 1-alkyl-3-methylimidazolium diclofenate ([C n mim][DF]; n = 6, 8, 10, 12, and 14) abbreviated as DF-ILs, wherein DF- is a well-recognized analgesic and nonsteroidal anti-inflammatory drug. We show strong synergistic interactions between C n mim+ and aromatic DF- attributed to reduced electrostatic repulsions and increased hydrophobicity from their incorporation, reflecting a 300-fold smaller critical aggregation concentration than that of their Cl- analogue [C n mim][Cl]. Interfacial properties for such strongly associating systems are discussed and clearly established to have remarkably improved properties than those of their Cl- analogues. The decreasing polarity of the cybotactic region of pyrene with increase in the chain length "n" indicates an increased extent of packing of cationic head groups in the Stern layer. DF- ion seems to play a vital role in the formation of the resulting aggregates, as probed by small angle neutron scattering and transmission electron microscopy. The thermodynamical insights of the aggregation process have been studied using isothermal titration calorimetry and temperature-dependent conductivity experiments. Unilamellar vesicles are formed at extremely low concentration, and also it is the first report that puts into picture the formation of vesicles for [C6mim][DF] with such a short chain.

Flavonoid-surfactant interactions: A detailed physicochemical study.

The aim of this article is to study the interactions between flavonoids and surfactants with attention of finding the probable location of flavonoids in micellar media that can be used for controlling their antioxidant behavior. In present study, the micellar and interfacial behavior of twin tailed anionic surfactants viz. sodium bis(2-ethylhexyl)sulfosuccinate (AOT) and sodium bis(2-ethylhexyl)phosphate (NaDEHP) in the presence of two flavonoids, namely quercetin (QUE) and kaempferol (KFL) have been studied by surface tension measurements. UV-visible, fluorescence and differential pulse voltammetric (DPV) measurements have been employed to predict the probable location of flavonoids (QUE/KFL) within surfactant (AOT/NaDEHP) aggregates. Dynamic light scattering (DLS) measurements further confirmed the solubilization of QUE/KFL in AOT/NaDEHP aggregates deduced from increased hydrodynamic diameter (Dh) of aggregates in the presence of flavonoids. Both radical scavenging activity (RSA) and degradation rate constant (k) of flavonoids are found to be higher in NaDEHP micelles as compared to AOT micelles.

Composition and Concentration Gradient Induced Structural Transition from Micelles to Vesicles in the Mixed System of Ionic Liquid-Diclofenac Sodium.

Catanionic surfactant-hydrotrope mixtures have proven to be a striking alternative to tune microstructures over a wide range of compositions and also to minimize precipitation that is normally observed in catanionic mixtures at an equimolar ratio. These mixtures are supposed to be of great relevance in biological systems when a hydrotrope is a "drug". Keeping this in view, here we report composition- and dilution-induced structural changes in a catanionic mixture comprising ionic liquids (ILs), such as 1-dodecyl-3-methylimidazolium bromide (C12mimBr)/1-tetradecyl-3-methylimidazolium bromide (C14mimBr), and a drug, diclofenac sodium (DFNa), in aqueous solution. The structural changes are probed by small-angle neutron scattering (SANS), dynamic light scattering (DLS), and zeta-potential measurements. SANS data and size distribution curves clearly depict the formation of low curvature structures on going from the cation-rich to anion-rich composition up to a 0.7 mole fraction of DFNa (XDFNa). The amphiphilic nature of DFNa is supposed to alter the surface charge density, which is provoked by its incorporation into resulting aggregates, as confirmed by modified zeta-potential values. The modification of the average packing parameter resulting from the IL and DFNa complexation equilibrium seems to play a vital role in bringing out structural transitions of mixed aggregates. We also focused our attention to study the effect of dilution in concentrations ranging from 100 to 25 mM. At XDFNa = 0.0 and 0.1, the size of prolate ellipsoids decreases on dilution, mimicking classic behavior, but an opposite trend is observed at other XDFNa values. Dilution-induced transformation to larger aggregates is thought to be driven by the release of DFNa molecules from the mixed micelles on account of the critical micelle concentration (cmc) (solubility) mismatch between the two components. The role of other interactions such as cation-π and π-π in stabilizing the mixed aggregates in addition to hydrophobic interactions is probed by (1)H NMR.

Probing interactions of neurotransmitters with twin tailed anionic surfactant: A detailed physicochemical study.

Keeping in view the role of neurotransmitters (NTs) in central nervous system diseases and in controlling various physiological processes, present study is aimed to study the binding of neurotransmitters (NTs) such as norepinephrine hydrochloride (NE) and serotonin hydrochloride (5-HT) with twin tailed surfactant sodium bis(2-ethylhexyl)sulfosuccinate (AOT). Spectroscopic and electrochemical measurements combined with microcalorimetric measurements were used to characterize the interactions between AOT and NTs. Meteoric modifications to emission profile and absorption spectra of NTs upon addition of AOT are indicative of the binding of NTs with AOT. Distinct interactional states such as formation of ion-pairs, induced and regular micelles with adsorbed NTs molecules have been observed in different concentration regimes of AOT. The formation of ion-pairs from oppositely charged NTs and AOT is confirmed by the reduced absorbance, quenched fluorescence intensity and decrease in peak current (ipa) as well as shifts in peak potential (Epa) values. The stoichiometry and formation of the NTs-AOT complexes has been judged and the extent of interactions is quantitatively discussed in terms of binding constant (K) and free energy of binding (ΔG°). The enthalpy (ΔH°mic) and free energy of micellization (ΔG°mic) for AOT in presence and absence of NTs are determined from the enthalpy curves.

A quantitative appraisal of the binding interactions between an anionic dye, Alizarin Red S, and alkyloxypyridinium surfactants: a detailed micellization, spectroscopic and electrochemical study.

The interactions of an anionic redox-active dye Alizarin Red S (ARS) with novel N-hydroxyethyl-3-alkyloxypyridinium surfactants 1-(2-hydroxyethyl)-3-(tetradecyloxy)pyridinium bromide, [HEC14OPyBr], and 1-(2-hydroxyethyl)-3-(hexadecyloxy)pyridinium bromide, [HEC16OPyBr], were investigated in an aqueous solution for the first time with an attempt to obtain comprehensive knowledge of oppositely charged dye-surfactant mixed systems. Different state-of-the-art techniques viz. conductivity, surface tension (ST), UV-visible spectroscopy, cyclic voltammetry (CV), linear sweep voltammetry (LSV), potentiometry, dynamic light scattering (DLS) and (1)H-NMR analysis have been employed. The presence of ARS decreases the critical micelle concentration (cmc) of alkyloxypyridinium surfactants as the ARS monomers behave as aromatic counterions. A combined analysis of the techniques revealed the existence of cation-π, π-π stacking, H-bonding, electrostatic and hydrophobic interactions among ARS and alkyloxypyridinium surfactants. A quantitative appraisal of the process of interaction among ARS and alkyloxypyridinium surfactants has been made in terms of various micellar, binding and electrochemical parameters evaluated using ST, UV-visible and voltammetric measurements. Also, the results extracted from (1)H-NMR and voltammetric measurements indicate that the catechol moiety of ARS is involved in the binding mechanism among ARS and alkyloxypyridinium surfactants.

Interactional behavior of the polyelectrolyte poly sodium 4-styrene sulphonate (NaPSS) with imidazolium based surface active ionic liquids in an aqueous medium.

The present study aims to develop an understanding of the interactions between an anionic polyelectrolyte, poly sodium 4-styrene sulphonate (NaPSS), and cationic surface active imidazolium based ionic liquids (SAILs), [Cnmim][Cl] (n = 10, 12, 14) using a multi-technique approach. Various physicochemical and electrochemical techniques such as surface tension, conductivity, fluorescence, isothermal titration calorimetry (ITC), dynamic light scattering (DLS), turbidity, potentiometry, cyclic voltammetry (CV), and differential pulse voltammetry (DPV) are employed to obtain comprehensive information about NaPSS-SAIL interactions. Different stages of interaction, corresponding to the critical aggregation concentration (cac), critical saturation concentration (Cs) and critical micelle concentration (cmc) have been observed owing to the strong electrostatic and hydrophobic interactions, and the results obtained from different techniques complement each other very well. The results extracted from DLS and turbidity measurements clearly indicated that the size of the micelle like aggregates first decreases and then increases in the presence of polyelectrolyte. The binding isotherms obtained using potentiometry show a concentration dependence and the highly co-operative nature of the interactions which is attributed to aggregation of the polyelectrolyte-SAIL complexes. The diffusion coefficients (Dm) of the electroactive probe in the pure and NaPSS-SAIL mixed systems were obtained, which were further used to obtain the values of the micellar self-diffusion coefficients (D) and inter-micellar interaction parameters (kd).

HIV-Associated Neurocysticercosis.

Few cases of HIV and neurocysticercosis co-infection have been reported till date. The symptomatic manifestation of cysticercosis may be further reduced by interactions between the 2 disease processes. In patients with HIV, the diagnosis of neurocysticercosis is challenging and management must be individualized depending on the stage and the coexistent opportunistic conditions. We present 2 such cases. First was a 35-year-old driver seropositive for HIV-1 presented with complex partial seizures and a CD4 count of 530 cells/mm(3). The second case was a 40-year-old businessman with a CD4 count of 350 cells/mm(3). Both of them had multiple parenchymal lesions, with 1 being a large cystic lesion. Relatively high CD4 count and a positive enzyme-linked immunosorbent assay increased the likelihood for diagnosis and treatment. Both of our patients received cysticidal therapy, and none of them deteriorated with treatment.

Pyogenic liver abscess caused by Salmonella Enteritidis: a rare case report.

Salmonella Enteritidis is one of the most important serovars transmitted from animals to humans and a serovar most commonly reported worldwide. Infection with Enteritidis is mainly limited to the intestinal tract, but under certain circumstances may cross the mucosal barrier to disseminate and get established as some localized infectious focus. Although cited as one of the very uncommon causes, Enteritidis may involve the liver and evolve into an overt abscess. Pyogenic liver abscess by a gas forming organism like Enteritidis usually follow a serious fulminant course and associated morbidity and mortality is unacceptably high unless immediate therapeutic interventions are initiated.