Spectrum of pathogens and their antimicrobial susceptibility pattern isolated from bronchoalveolar lavage specimens at a hilly area in Uttarakhand.

Background: Lower respiratory tract infections (LRTIs) are associated with significant morbidity and mortality in all age groups, especially young children and the elderly population. Various gram-positive and gram-negative organisms such as Streptococcus spp., Pseudomonas spp., and Klebsiella spp. have been implicated as a pathogen in bronchoalveolar lavage (BAL) specimens collected from such patients. Aims and Rationale of the Study: The present study is aimed at assessing the spectrum of the bacterial isolates and determining the antimicrobial resistance obtained from the BAL fluid from admitted patients at various wards and intensive care units (ICUs) of a tertiary care hospital in Dehradun. This will be the stepping stone in our efforts toward becoming a future antimicrobial steward and framing local antibiograms based on such data. Material and Methods: Two hundred BAL specimens were collected from patients admitted to various wards and ICUs of the hospital who were suffering from LRTI. The BAL specimens were subjected to direct microscopy and culture. Identification and susceptibility testing were performed. Results: The most predominant isolates were Pseudomonas aeruginosa (16/39 (41.02%)) followed by Klebsiella pneumoniae (7/39 (17.94%)) and Acinetobacter spp. (6/39 (15.38%)). Sixty-five percentage of Pseudomonas aeruginosa, 71% of Klebsiella pneumoniae, and 83% of Acinetobacter spp. showed intermediate results with colistin. Conclusion: Nonfermenters constitute a significant group of organisms isolated from bronchoalveolar lavage (BAL) specimens in patients with lower respiratory tract infections (LRTIs). Hence, it is extremely important to correctly identify and determine the resistance pattern of such isolates so that appropriate empirical therapy can be initiated for the benefit of the patient.

Prevalence of ventilator-associated events and antibiogram of bacterial isolates of ventilator-associated pneumonia in a tertiary care hospital of Uttarakhand.

Background and Objectives: Despite progress in diagnosing and managing ventilator-associated pneumonia (VAP), ongoing monitoring of ventilator-associated events (VAE) is crucial due to VAP's persistent prominence as the primary cause of Hospital-Acquired Infection (HAI) among Intensive Care unit patients. This study was done to illuminate the prevalence of VAE and antibiogram of bacterial isolates of VAP in a tertiary care hospital of Uttarakhand. Materials and Methods: This cross-sectional study focused on ICU patients. Adult patients ventilated for > 2 days were monitored daily, with VAE data analyzed using Center of Disease Control & Prevention (CDC) criteria. Specimens were sent to the Microbiology Department and cultured on Blood agar and MacConkey agar. Identification and antimicrobial profiles of isolates were determined using Vitek-2 Compact. Results: 1220 ventilated individuals were assessed in total. VAE was diagnosed in 6.4% (78/1220) of the patients, the same later developed ventilator associated condition (VAC), 74 developed the infection-related VAC (IVAC), and 60 developed the possible/probable VAP (PVAP) among the 78 VAE cases. Klebsiella pneumoniae (35%), Acinetobacter baumannii (33%), and Pseudomonas aeruginosa (16%) were the most common isolated organisms. Colistin (57%) was the most effective against Klebsiella pneumoniae, followed by amikacin (28.5%) and trimethoprim+sulfamethoxazole (24%). Pseudomonas aeruginosa was most susceptible to imipenem (70%), meropenem, cefoperazone+sulbactam, and colistin (60%). Acinetobacter baumannii was most susceptible to colistin (85%), tigecycline (65%), and trimethoprim+sulfamethoxazole (25%). Conclusion: The most common cause of HAI is VAP. The purpose of this study is to determine the importance of starting suitable antibiotics early for prognosis and the difficulty of diagnosing VAP.

Bacterial Isolates and Their Antimicrobial Susceptibility Profile in Osteomyelitis Patients: An Experience From a Tertiary Care Center in a Hilly Area of Uttarakhand.

Osteomyelitis, an infection related to bone and bone marrow, is very diverse in its pathophysiology and clinical presentation; hence, it is considered one of the most difficult-to-treat infections. The present study is aimed at assessing the microbiological profile of osteomyelitis and related antimicrobial susceptibility patterns in patients attending a tertiary care center in Uttarakhand, India, over a period of one year (January to December 2019). In aerobic culture, 58/105 (55.2%) bacterial isolates were detected. In addition, Staphylococcus aureus was the most common isolate, and amongst Gram-negative bacilli, most isolates that grew on culture were Escherichia coli (22.4%). Out of 21 S. aureus isolates, methicillin resistance was detected in nine [9/21 (42%)] cases, which is a matter of concern. Hence, proper training and application of antimicrobial stewardship are the need of the hour so that clinicians can initiate targeted therapy as early as possible.

Microbial profile and antibiotic resistance pattern of water supply in a tertiary care hospital of Uttarakhand.

Background and Objectives: In healthcare settings, hospital water and water-related devices can act as a reservoir for waterborne infections. Potable water, sinks, faucet aerators, showers, tub immersion, toilets, dialysis water, water baths, eyewash stations, and dental-unit water stations have all been linked to nosocomial outbreaks. This study aimed to determine the microbial profile and pattern of antibiotic resistance in the water supply of a tertiary care hospital in Uttarakhand. Materials and Methods: This is a 1-year prospective study which was carried out by the Department of Microbiology and Immunology at Sri Mahant Indersh Hospital (SMIH), Dehradun. A total of 154 water samples were collected from the AC outlets, ventilators in the Intensive care unit (ICUs), Operation theatre (OTs), and High dependency unit (HDUs), scrub stations, pantry, and blood bank, patient's bathroom, private ward, septic ward, labour room, transplant unit, laboratory, scope rinse water, the dialysis unit and tank throughout the hospital, including tap water (pre and post flush [25%]), tap swabs (24%), drinking water (9%), AC outlets (13%), and other areas (3%). Results: 30 of the 154 (19.5%) water samples tested were culture-positive. The most contaminated water samples were tap swabs (27%, n = 8/30). A total of nine organisms were isolated, of which the most predominant was Pseudomonas aeruginosa (40%; 12/30), followed by Legionella pneumophila (13%; 4/30), Acinetobacter baumanii (10%; 3/30), Klebsiella pneumoniae (10%; 3/30), Escherichia coli (7%; 2/30), Enterococcus faecalis (7%; 2/30), Aspergillus flavus (7%; 2/30), Stenotrophomonas (3%; 1/30), and Fusarium spp. (3%; 1/30). Gram-negative bacilli and non-lactose fermenting (GNB and NLF) showed a high rate of contamination, 53.3% (n = 16/30). P. aeruginosa showed resistance to gentamicin and amikacin (42%), imipenem (50%), levofloxacin (58%), and colistin (25%), while Acinetobacter baumanii showed resistance to gentamicin and amikacin (67%), minocycline (63%), and levofloxacin, imipenem and colistin (33%). Conclusion: The study's findings show that a variety of microorganisms are contaminating hospital water supplies and can be a source of hospital-acquired infections. A suitable and robust surveillance program for hospital water supplies, as well as strict adherence to infection control practices, is strongly advised.

Synergistic soil-less medium for enhanced yield of crops: a step towards incorporating genomic tools for attaining net zero hunger.

Globally, industrial farming endangers crucial ecological mechanisms upon which food production relies, while 815 million people are undernourished and a significant number are malnourished. Zero Hunger aims to concurrently solve global ecological sustainability and food security concerns. Recent breakthroughs in molecular tools and approaches have allowed scientists to detect and comprehend the nature and structure of agro-biodiversity at the molecular and genetic levels, providing us an advantage over traditional methods of crop breeding. These bioinformatics techniques let us optimize our target plants for our soil-less medium and vice versa. Most of the soil-borne and seed-borne diseases are the outcomes of non-treated seed and growth media, which are important factors in low productivity. The farmers do not consider these issues, thereby facing problems growing healthy crops and suffering economic losses. This study is going to help the farmers increase their eco-friendly, chemical residue-free, quality yield of crops and their economic returns. The present invention discloses a synergistic soil-less medium that consists of only four ingredients mixed in optimal ratios by weight: vermicompost (70-80%), vermiculite (10-15%), coco peat (10-15%), and Rhizobium (0-1%). The medium exhibits better physical and chemical characteristics than existing conventional media. The vermiculite to coco peat ratio is reduced, while the vermicompost ratio is increased, with the goals of lowering toxicity, increasing plant and water holding capacity, avoiding drying of the media, and conserving water. The medium provides balanced nutrition and proper ventilation for seed germination and the growth of seedlings. Rhizobium is also used to treat the plastic bags and seeds. The results clearly show that the current synergistic soil-less environment is best for complete plant growth. Securing genetic advantages via sexual recombination, induced random mutations, and transgenic techniques have been essential for the development of improved agricultural varieties. The recent availability of targeted genome-editing technology provides a new path for integrating beneficial genetic modifications into the most significant agricultural species on the planet. Clustered regularly interspaced short palindromic repeats and associated protein 9 (CRISPR/Cas9) has evolved into a potent genome-editing tool for imparting genetic modifications to crop species. In addition, the integration of analytical methods like population genomics, phylogenomics, and metagenomics addresses conservation problems, while whole genome sequencing has opened up a new dimension for explaining the genome architecture and its interactions with other species. The in silico genomic and proteomic investigation was also conducted to forecast future investigations for the growth of French beans on a synergistic soil-less medium with the purpose of studying how a blend of vermicompost, vermiculite, cocopeat, and Rhizobium secrete metal ions, and other chemical compounds into the soil-less medium and affect the development of our target plant as well as several other plants. This interaction was studied using functional and conserved region analysis, phylogenetic analysis, and docking tools.

Coronavirus disease (COVID-19)-associated mucormycosis (CAM): The unholy triad of COVID-19, diabetes mellitus, and corticosteroid therapy.

The whole world has battled with multiple waves of coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 virus. However, the second wave of COVID-19 had caused a worldwide havoc in terms of disease transmissibility, severity, and mortality. India has been among the worst hit countries during the second wave, which substantially overburdened and overwhelmed the Indian health care system. While secondary infections and co-infections among COVID-19 patients were increasingly being reported, COVID-19-associated mucormycosis (CAM) emerged as a new challenge particularly from India and became a matter of immediate concern. The most common causes attributed to the rise of CAM were undiagnosed/uncontrolled diabetes mellitus, excessive use of corticosteroids, and prolonged hospital stay, all of which create a perfect environment for mucormycosis infection to set in.

A Review of Anti-Cancer and Related Properties of Lichen-Extracts and Metabolites.

BACKGROUND: Lichens are a composite consortium of a fungus and an alga. The symbiotic organisms are naturally equipped with distinct characteristics as compared to constituting organisms separately. Lichens, due to their peculiar anatomy and physiology, are the reservoir of more than 600 unique secondary metabolites, also known as 'lichen substances'. Since ancient times, many ethnic groups from various parts of the world have known about the applications of lichens as major provenance of food/fodder, medicine, dyes, spices, perfumes, etc. Lichen substances have shown impressive antioxidant, antimicrobial, antiviral, anti-tumor, and antiinflammatory activities under experimental conditions. Usnic acid, a well-known metabolite found in several species of lichens, possesses potent antioxidant and anti-inflammatory activities. It also has significant antiproliferative potential, as revealed through testing in different cancer cell lines. Atranorin, Lecanoric acid, Norstictic acid, Lobaric acid, Stictic acid, Ramalin, Gyrophoric acid, Salazinic acid, Protolichesterinic, and Fumarprotocetraric acid are some of the other purified lichen-metabolites with potent anti-cancer activities. OBJECTIVE: This study presents an overview of lichen-derived extracts and compounds showing anti-cancer (or related) properties. METHOD: The review comprehends different studies (in vivo and in vitro) backing up the possibility of lichenextracts and metabolites towards their use as antioxidant, anti-proliferative, anti-inflammatory, and Epithelialmesenchymal transition (EMT) -inhibiting agents. RESULTS: Various studies carried out to date show that lichen-extracts and metabolites have a range of anti-cancer and related properties that include anti-oxidative, anti-inflammatory, anti-proliferative, pro-apoptotic, and the potential of inhibition of cancer-associated EMT that is responsible for drug resistance and metastasis of cancer cells in a substantial proportion of cases. CONCLUSION: Lichens are the repertoire of a plethora of lichen-metabolites with significant anti-cancer potential. However, some of the critical 'anti-cancer related' properties, such as the ability of EMT-inhibition and the potential of induction of apoptosis, are relatively less studied for several lichen compounds. Additionally, many lichen compounds need to be purified at a larger scale to explore their anti-cancer potential.

Recent Advances in Cardiac Tissue Engineering for the Management of Myocardium Infarction.

Myocardium Infarction (MI) is one of the foremost cardiovascular diseases (CVDs) causing death worldwide, and its case numbers are expected to continuously increase in the coming years. Pharmacological interventions have not been at the forefront in ameliorating MI-related morbidity and mortality. Stem cell-based tissue engineering approaches have been extensively explored for their regenerative potential in the infarcted myocardium. Recent studies on microfluidic devices employing stem cells under laboratory set-up have revealed meticulous events pertaining to the pathophysiology of MI occurring at the infarcted site. This discovery also underpins the appropriate conditions in the niche for differentiating stem cells into mature cardiomyocyte-like cells and leads to engineering of the scaffold via mimicking of native cardiac physiological conditions. However, the mode of stem cell-loaded engineered scaffolds delivered to the site of infarction is still a challenging mission, and yet to be translated to the clinical setting. In this review, we have elucidated the various strategies developed using a hydrogel-based system both as encapsulated stem cells and as biocompatible patches loaded with cells and applied at the site of infarction.

Phytomedicines Targeting Cancer Stem Cells: Therapeutic Opportunities and Prospects for Pharmaceutical Development.

The presence of small subpopulations of cells within tumor cells are known as cancer stem cells (CSCs). These cells have been the reason for metastasis, resistance with chemotherapy or radiotherapy, and tumor relapse in several types of cancers. CSCs underwent to epithelial-mesenchymal transition (EMT) and resulted in the development of aggressive tumors. CSCs have potential to modulate numerous signaling pathways including Wnt, Hh, and Notch, therefore increasing the stem-like characteristics of cancer cells. The raised expression of drug efflux pump and suppression of apoptosis has shown increased resistance with anti-cancer drugs. Among many agents which were shown to modulate these, the plant-derived bioactive agents appear to modulate these key regulators and were shown to remove CSCs. This review aims to comprehensively scrutinize the preclinical and clinical studies demonstrating the effects of phytocompounds on CSCs isolated from various tumors. Based on the available convincing literature from preclinical studies, with some clinical data, it is apparent that selective targeting of CSCs with plants, plant preparations, and plant-derived bioactive compounds, termed phytochemicals, may be a promising strategy for the treatment of relapsed cancers.

Possible Role of Curcumin as an Efflux Pump Inhibitor in Multi Drug Resistant Clinical Isolates of Pseudomonas aeruginosa.

INTRODUCTION: Multidrug resistant non-fermenters are continuously increasing in hospital and ICU settings. One of the mechanisms of developing drug resistance is possession of efflux pump through which bacteria extrude antimicrobial agents and other toxic substances. If these efflux channels are blocked or inhibited, increased drug concentration can be achieved in a bacterial cell with optimal drug dose. Present study was aimed to investigate role of curcumin as efflux pump inhibitor (EPI) and to compare its activity with a known EPI like phe-arg-beta-naphthylamide (PAßN). MATERIALS AND METHODS: A total of 170 clinical isolates of Pseudomonas aeruginosa were taken, antimicrobial susceptibility was performed by disc diffusion test and minimum inhibitory concentration (MIC) against selected drugs before and after adding known synthetic EPI, PAßN (20mg/L). Out of these, 30 multidrug resistant strains were taken and MIC was performed with curcumin (50mg/L) with and without selected drugs. Results : Significant reduction in MIC was observed after adding curcumin (50mg/L) with selected antimicrobial agents in 9/30 (30%) of multi drug resistant (MDR) isolates of Pseudomonas aeruginosa, while no change in MIC was observed when curcumin (50mg/L) was used alone, indicating its efflux pump inhibitor activity. CONCLUSION: This study suggests role of efflux pump in development of drug resistance which can be overcome by use of an efflux pump inhibitor, with more emphasis on compound like curcumin which will have less or no adverse effects if used in vivo.