Ceftazidime-Avibactam resistance in clinical isolates of carbapenem-resistant Klebsiella pneumoniae: A phenotypic and genotypic analysis.

OBJECTIVE: To find the prevalence of Ceftazidime-Avibactam (CAZ-AVI) resistant Klebsiella pneumoniae in clinical isolates and to determine the genes responsible for Ceftazidime-Avibactam resistance using PCR. METHODS: A total of 89 carbapenem resistant Klebsiella pneumoniae from various clinical samples were included in the study. CAZ-AVI resistance was tested using E-test. CAZ-AVI resistant strains were subjected to conventional PCR for detection of carbapenamase genes blaNDM- 1, blaOXA-48, blaVIM, blaIMP, blaKPC. RESULTS: Of the 89 isolates screened for CAZ-AVI resistance, 45(50.5%) isolates were found to be resistant. 42 isolates were subjected to PCR for detection of ß lactamase genes.34 isolates were positive for blaNDM-1 and all 42 isolates were positive for blaOXA-48. Co-expression of NDM-1 and OXA-48 was seen in 34 isolates. Sensitivity of mCIM test to identify a carbapenamse compared to PCR was 61.9%. Sensitivity of eCIM test to identify NDM-1 was 80%. CONCLUSION: CAZ-AVI was effective in vitro in 49.4% of the isolates. Indicating that CAZ-AVI is a promising addition to antibiotics against CRE as well as a carbapenem sparing drug in ESBL producing organisms. ß-Lactamase-related mutations are the main mechanism leading to CAZ-AVI resistance.

Unraveling determinants of integrated farming systems adoption for sustainable livelihood and dietary diversity.

Introduction: Over the years, smallholder farmers have faced more vulnerability to risk and uncertainty in India due to their dependence on cereal crops. One way to reduce this risk is through diversified agriculture, integrating different practices for efficient resource utilization, and adopting a farming systems approach. An integrated farming system (IFS) is one such technique that provides year-round income from different components of enterprises. However, the decision to adopt IFS may be determined by several characteristics of farmers, which needs to be delineated through impact analysis to harness the benefits of a systems approach. Methods: This study analyzes the economic effects of integrated farming systems and assesses their determinants, as well as the dietary diversity patterns of farmers in two states of southern India, i.e., Kerala and Tamil Nadu. A multistage sampling technique was used to obtain cross-sectional data from 367 farmers randomly chosen from one district in Kerala and two districts in Tamil Nadu. The participants have Crop + Horticulture + Animal husbandry (45.45%) as their major system, whereas non-participants have Crop + Animal husbandry (44.35%) as their predominant system. Coarsened exact matching and logit regression methods were used to evaluate the economic impacts of IFS and its influencing factors. Results: The findings of the study indicate that age, education, livestock holding, access to credit, and plantation area have a positive and significant effect on participation by farmers in the program. The matching results show that adoption of IFS resulted in a significant economic impact, generating an additional gross income of Rs. 36,165 ha-1 and a net income of Rs. 35,852 ha-1 and improving the dietary diversity of farm households by 8.6% as compared to non-adopters. Discussion: This study suggests that IFS is a promising approach for improving farmers' livelihoods, economic gains, and nutritional security. Therefore, the integrated farming systems models need to be upscaled through the convergence of government schemes in other regions of India to support smallholder farmers' farming.

Cerebral phaeohyphomycosis due to Cladophialophora bantiana: case report and systematic review of cases.

PURPOSE: Cladophialophora bantiana is a wonted melanized fungus causing brain abscess. In past many cases were reported from Asia, particularly from India. Of late, there is a rise in cases in places besides Asia and hence a review of the cases is warranted. METHODS: We present a case of fatal cerebral phaeohyphomycosis caused by C. bantiana and conduct a systematic review of culture confirmed brain abscess due to C. bantiana reported between 2015 and 2022. RESULTS: Of the 39 cases found, majority (68%) were immunocompromised. The various clinical presentations were headache (53%), hemiparesis (34%), visual disturbance (25%), altered sensorium (18%), aphasia/dysarthria (12%) and seizures (9%). Isolated lesion was observed in 18 (60%) patients. In the sequence of occurrence, the lesions were in frontal (30%), temporal (27%) and parietal (20%) region. There were five cases with coinfections such as concurrent detection of Nocardia pneumonia in two cases, toxoplasma DNA in brain abscess, coexisting pulmonary Cryptococcus neoformans infection and coexisting Candida in a case of brain abscess in one case each. Surgical intervention was performed in 84% cases. Antifungal therapy included voriconazole (80%), liposomal amphotericin B (76%), 5-fluorocytosine (30%), posaconazole (10%), and amphotericin B deoxycholate (6%). The overall mortality was 50% with lower mortality (42%) in regions outside Asia compared to Asia (63.6%) though not statistically significant. CONCLUSIONS: C. bantiana brain abscess is an emerging infection worldwide. Next generation sequencing is an upcoming promising diagnostic test. Early complete excision of the lesion with effective antifungals may improve the outcome.

Pulmonary tuberculosis and neurologic melioidosis coinfection-first case report from Madurai.

Despite tuberculosis and melioidosis being endemic in many countries, coinfections are unusual. Only fourteen cases of tuberculosis melioidosis coinfections have been reported. To the best of our knowledge, this is the first case of coinfection of tuberculosis and neurologic melioidosis. We report a case of 48 year diabetic male presented with fever, headache and altered sensorium for two days. On examination, there was scalp abscess with subgaleal hematoma, pus culture of which grew B. pseudomallei. Sputum culture grew the same and sputum tuberculosis PCR was positive. Patient was concurrently treated for both the conditions and recovered.

Case series of aspergillus spondylodiscitis from a tertiary care centre in India.

Aspergillus spondylodiscitis is a rare entity reported in the literature. In tuberculosis endemic regions like India, more often it could be misdiagnosed as tuberculous spondylodiscitis. Herein we report a case series of three patients with Aspergillus spondylodiscitis presenting with chronic low backpain and clinically diagnosed as tuberculosis spine. Culture and histopathological examination of the debrided tissue provided a definite diagnosis. Interestingly, one of the cases had coexisting tuberculosis spine. All three patients underwent surgical intervention-debridement, decompression and fusion of spine and combined medical management with voriconazole with successful outcome.

Regulatory landscape of risk assessment of pesticide residues in processed foods in India: a perspective.

In India, the levels of pesticide residues in Raw Agricultural Commodities (RAC) are being subjected to adequate legal regulations, and the health-risks associated with them are determined from time to time adhering to global standards. Since RACs are generally consumed by humans as the processed foods (PF), it is imperative to monitor the levels of pesticide residues in them in order to approach a realistic analysis of dietary exposure and concomitant health risk assessment. In India, production and consumption of PFs have a rising trend and hence it is indispensable to monitor the residue levels of pesticides in largely consumed PFs. Depending on the processing methods and physicochemical properties of pesticides, the residue levels may decrease or increase in a PF when compared to the corresponding RAC. While obtaining data on processing factors (Pf), it is pragmatic to focus on those situations in which the residues get concentrated following the processing step. Currently, regulatory agencies of several countries and the CODEX have determined the levels of pesticide residues in processed agriculture commodities, arrived at the Pfs, and fixed the maximum residue levels. Since consumption of PFs in India has tremendously increased in recent times and there is paucity of data about their health risks/benefits, it is imminent to deliberate on the complexities associated with the issues of adopting the Pfs generated by other regulatory agencies and subsequently examine the possibilities of generating the required data on Pfs on a priority basis to enable a comprehensive risk assessment.

Risk Factors and Clinical Outcomes of Stenotrophomonas maltophilia Infections: Scenario in a Tertiary Care Center from South India.

Stenotrophomonas maltophilia, a gram-negative non-fermenter has evolved from a colonizer to a significant pathogen over the last decade. It resides in various ecological niches both inside and outside the hospital settings. Infections due to S. maltophilia can be life-threatening, especially in immunocompromised patients. S. maltophilia is intrinsically resistant to most of the antibiotics, which limits treatment options. There are several risk factors involved. The present study was done to assess the risk factors and clinical outcomes associated with S. maltophilia blood stream infections and non-blood stream infections. How to cite this article: Varshini MK, Ganesan V, Sundaramurthy R, Rajendran T. Risk Factors and Clinical Outcomes of Stenotrophomonas maltophilia Infections: Scenario in a Tertiary Care Center from South India. Indian J Crit Care Med 2022;26(8):935-937.

A Torn ACL Mapping in Knee MRI Images Using Deep Convolution Neural Network with Inception-v3.

The anterior cruciate ligaments (ACL) are the fundamental structures in preserving the common biomechanics of the knees and most frequently damaged knee ligaments. An ACL injury is a tear or sprain of the ACL, one of the fundamental ligaments in the knee. ACL damage most generally happens during sports, for example, soccer, ball, football, and downhill skiing, which include sudden stops or changes in direction, jumping, and landings. Magnetic resonance imaging (MRI) has a major role in the field of diagnosis these days. Specifically, it is effective for diagnosing the cruciate ligaments and any related meniscal tears. The primary objective of this research is to detect the ACL tear from MRI knee images, which can be useful to determine the knee abnormality. In this research, a Deep Convolution Neural Network (DCNN) based Inception-v3 deep transfer learning (DTL) model was proposed for classifying the ACL tear MRI images. Preprocessing, feature extraction, and classification are the main processes performed in this research. The dataset utilized in this work was collected from the MRNet database. A total of 1,370 knee MRI images are used for evaluation. 70% of data (959 images) are used for training and testing, and 30% of data (411 images) are used in this model for performance analysis. The proposed DCNN with the Inception-v3 DTL model is evaluated and compared with existing deep learning models like VGG16, VGG19, Xception, and Inception ResNet-v28. The performance metrics like accuracy, precision, recall, specificity, and F-measure are evaluated to estimate the performance analysis of the model. The model has obtained 99.04% training accuracy and 95.42% testing accuracy in performance analysis.

Investigations on Brain Tumor Classification Using Hybrid Machine Learning Algorithms.

The imaging modalities are used to view other organs and analyze different tissues in the body. In such imaging modalities, a new and developing imaging technique is hyperspectral imaging. This multicolour representation of tissues helps us to better understand the issues compared to the previous image models. This research aims to analyze the tumor localization in the brain by performing different operations on hyperspectral images. The tumor is located using the combination of k-based clustering processes like k-nearest neighbour and k-means clustering. The value of k in both methods is determined using the optimization process called the firefly algorithm. The optimization processes reduce the manual calculation for finding K's optimal value to segment the brain regions. The labelling of the areas of the brain is done using the multilayer feedforward neural network. The proposed technique produced better results than the existing methods like hybrid k-means clustering and parallel k-means clustering by having a higher peak signal-to-noise ratio and a lesser mean absolute error value. The proposed model achieved 96.47% accuracy, 96.32% sensitivity, and 98.24% specificity, which are improved compared to other techniques.

Segmentation and Classification of Glaucoma Using U-Net with Deep Learning Model.

Glaucoma is the second most common cause for blindness around the world and the third most common in Europe and the USA. Around 78 million people are presently living with glaucoma (2020). It is expected that 111.8 million people will have glaucoma by the year 2040. 90% of glaucoma is undetected in developing nations. It is essential to develop a glaucoma detection system for early diagnosis. In this research, early prediction of glaucoma using deep learning technique is proposed. In this proposed deep learning model, the ORIGA dataset is used for the evaluation of glaucoma images. The U-Net architecture based on deep learning algorithm is implemented for optic cup segmentation and a pretrained transfer learning model; DenseNet-201 is used for feature extraction along with deep convolution neural network (DCNN). The DCNN approach is used for the classification, where the final results will be representing whether the glaucoma infected or not. The primary objective of this research is to detect the glaucoma using the retinal fundus images, which can be useful to determine if the patient was affected by glaucoma or not. The result of this model can be positive or negative based on the outcome detected as infected by glaucoma or not. The model is evaluated using parameters such as accuracy, precision, recall, specificity, and F-measure. Also, a comparative analysis is conducted for the validation of the model proposed. The output is compared to other current deep learning models used for CNN classification, such as VGG-19, Inception ResNet, ResNet 152v2, and DenseNet-169. The proposed model achieved 98.82% accuracy in training and 96.90% in testing. Overall, the performance of the proposed model is better in all the analysis.

Mucormycosis in a Tertiary Care Center in South India: A 4-Year Experience.

BACKGROUND: Mucormycosis is an emerging fungal infection in both developed and developing countries with different target population. Unusual isolates and unusual clinical presentations have been reported from India in recent times. OBJECTIVES: The present study was done to know the epidemiology, risk factors, diagnostic modalities, and treatment outcome of mucormycosis patients in our hospital. MATERIALS AND METHODS: The study was carried out over a period of 4 years from October 2015 to October 2019. This is a retrospective observational chart review of patients diagnosed with proven and probable mucormycosis. Information on demography, clinical features, risk factors, laboratory and radiological findings, treatment (including medical and surgical treatment), and outcome was extracted from the records. Primary outcome at 42 days was determined. RESULTS: Thirty-eight patients were diagnosed with mucormycosis based on microbiological and/or histopathological examination (HPE) of the clinical samples. Most commonly affected age-group was between 41 years and 60 years. More number of cases were reported during the months of post rainy season (September to December). A large number of patients (77%) presented with uncontrolled diabetes mellitus. Rhino-orbito-cerebral mucormycosis was the most common presentation followed by cutaneous infection. Antifungal treatment was started in around 80% of the cases. Twenty patients were managed by combined medical and surgical intervention. Eight patients died while the outcome of nine was unknown, as they left the hospital against medical advice and could not be followed up. CONCLUSION: Mucormycosis, an insidious killer, should be an important differential diagnosis in progressive soft tissue infections and deep organ infection. HOW TO CITE THIS ARTICLE: Priya P, Ganesan V, Rajendran T, Geni VG. Mucormycosis in a Tertiary Care Center in South India: A 4-Year Experience. Indian J Crit Care Med 2020;24(3):168-171.

Effects of prenatal bisphenol-A exposure and postnatal overfeeding on cardiovascular function in female sheep.

Bisphenol-A (BPA) is a widely used endocrine-disrupting chemical. Prenatal exposure to BPA is known to affect birth weight, but its impact on the cardiovascular system has not been studied in detail. In this study, we investigated the effects of prenatal BPA treatment and its interaction with postnatal overfeeding on the cardiovascular system. Pregnant sheep were given daily subcutaneous injections of corn oil (control) or BPA (0.5 mg/kg/day in corn oil) from day 30 to day 90 of gestation. A subset of female offspring of these dams were overfed to increase body weight to ~30% over that of normal fed controls. Cardiovascular function was assessed using non-invasive echocardiography and cuff blood pressure (BP) monitoring at 21 months of age. Ventricular tissue was analyzed for gene expression of cardiac markers of hypertrophy and collagen at the end of the observation period. Prenatal BPA exposure had no significant effect on BP or morphometric measures. However, it increased atrial natriuretic peptide gene expression in the ventricles and reduced collagen expression in the right ventricle. Overfeeding produced a marked increase in body weight and BP. There were compensatory increases in left ventricular area and internal diameter. Prenatal BPA treatment produced a significant increase in interventricular septal thickness when animals were overfed. However, it appeared to block the increase in BP and left ventricular area caused by overfeeding. Taken together, these results suggest that prenatal BPA produces intrinsic changes in the heart that are capable of modulating morphological and functional parameters when animals become obese in later life.

Evaluation of Ica Gene in Comparison with Phenotypic Methods for Detection of Biofilm Production by Coagulase Negative Staphylococci in a Tertiary Care Hospital.

BACKGROUND: Biofilm producing bacteria are responsible for several chronic infections and are difficult to treat as they show much greater resistance to antibiotics. The major virulence factor determining the pathogenicity of CoNS has now well defined and found to be biofilm production. OBJECTIVE: The study was conducted to isolate and characterize Coagulase Negative Staphylococci (CoNS) and their ability to form biofilms was evaluated by phenotypic and genotypic methods. MATERIALS AND METHODS: A total of 96 clinical isolates of CoNS were characterized and subjected to biofilm detection by tissue culture plate method (TCP), tube method (TM), congo red agar method (CRA) and PCR. RESULTS: Staphylococcus epidermidis was the most commonly isolated species 76(79.17%). The ica gene was present in 35 (36.45%) of CoNS isolates which were detected as biofilm producers by TCP. Biofilm producing isolates showed higher antibiotic resistance(72.1%). Majority of biofilm producers had strong association with medical device related infections. CONCLUSION: To compare PCR based dectection method for presence of ica genes with TCP, the test share the specific identification rates. The sensitivity and specificity of TCP method in detection of biofilm was high in comparison with TM and CRA. TCP can be recommended as a general screening test for biofilm detection.

Tubercular prostate abscess in an immunocompetent patient.

Prostate tuberculosis is an infrequent manifestation of genitourinary tuberculosis Complications like prostate abscess, perineal fistula, sinus can occur in immunocompromised individuals. Various predisposing factors like diabetes, bladder outlet obstruction, chronic renal failure can lead to prostate abscess. TRUS (Transrectal USG) is one of the tools useful for the diagnosis of prostatic abscess. We present our case, 57 year man, ethanolic with features of chronic liver disease and pulmonary tuberculosis which disseminated to prostate, developed abscess presenting as pyrexia of unknown origin.

Rhenium-based molecular rectangular boxes with large inner cavity and high shape selectivity towards benzene molecule.

The self-assembly of rhenium-based rectangular boxes with a large inner cavity can be achieved via a simple one-step synthetic route; these molecules selectively recognize planar aromatic molecules, benzene in particular.

Aggregate of alkoxy-bridged Re(I)-rectangles as a probe for photoluminescence quenching.

Alkoxy-bridged rhenium(I) rectangles [{(CO)(3)Re(mu-OR)(2)Re(CO)(3)}(2)(mu-bpy)(2)] (1, R = C(4)H(9); 2, R = C(8)H(17); 3, R = C(12)H(25); bpy = 4,4'-bipyridine) comprising long alkyl chains form optically transparent aggregates and exhibit luminescence enhancement in the presence of water. The aggregation of Re(I)-rectangle was followed using a light-scattering technique. Presumably, the enhanced luminescence efficiency resulted from restriction of torsional molecular motion in the aggregates. In addition, the rate of bimolecular quenching of Re(I)-aggregates in the triplet excited state by various electron donors (amines) and acceptors (quinones) was efficient. These results indicate that the excited state of aggregated Re(I) surfactants with an electron acceptor and donor facilitate the electron-transfer quenching process after they became preassociated inside the Re(I)-aggregated species. These synthesized compounds may be useful fluorescent materials in optoelectronic applications.

Micellar catalysis on the electron transfer reactions of iron(III)-polypyridyl complexes with organic sulfides-importance of hydrophobic interactions.

The oxidation of organic sulfides with iron(III)-polypyridyl complexes [Fe(NN)3]3+ proceeds through an electron transfer mechanism and an increase in the methanol content in the methanol-water mixture favors the reaction. The reaction is catalyzed by both the anionic surfactant, sodium dodecyl sulfate (SDS) and the cationic surfactant, cetyltrimethylammonium bromide (CTAB). The micellar catalysis in the presence of SDS is accounted for in terms of strong binding of the cationic oxidant with the anionic surfactant and the development of positive charge on sulfur center of substrate in the transition state. The micellar catalysis observed on the reaction involving a trication, [Fe(NN)3]3+, in the presence of CTAB indicates the importance of hydrophobic interaction between the micelle and hydrophobic ligand of [Fe(NN)3]3+. The micellar catalysis is explained in terms of a pseudophase ion exchange model.

Iliopsoas abscesses.

Iliopsoas abscess is a relatively uncommon condition that can present with vague clinical features. Its insidious onset and occult characteristics can cause diagnostic delays, resulting in high mortality and morbidity. The epidemiology, aetiology, clinical features, and management of iliopsoas abscess are discussed.

Synthesis and photophysical properties of neutral luminescent rhenium-based molecular rectangles.

A series of neutral luminescent molecular rectangles [[Re(CO)(3)(mu-bpy)Br][Re(CO)(3)(mu-L)Br]](2) (1-4) having fac-Re(CO)(3)Br as corners and 4,4'-bipyridine (bpy) as the bridging ligand on one side and other bipyridyl ligands of varying length (L) on the other side have been synthesized and characterized. The crystal structure of 1 shows a rectangular cavity with the dimensions of 11.44 x 7.21 A. When the cavity size is tuned from 1 to 4, a dimension of 11.4 x 20.8 A could be achieved, as revealed by the molecular modeling. These rectangles exhibit luminescence in solution at room temperature. In particular, compound 4 containing 1,4-bis(4'-pyridylethynyl)benzene (bpeb) as bridging ligand shows the excited-state lifetime of 495 ns. Fine-tuning of the cavity size of the rectangles improves their excited-state properties. These properties facilitate the study of excited-state electron-transfer reactions with electron acceptors and donors and host-guest binding. Crystallographic information: 1.6CH(3)COCH(3) is monoclinic, P2(1)/c, with a = 12.0890(2), b = 24.2982(2), and c = 12.8721(2) A, beta = 107.923(1) degrees, and Z = 2.

Self-assembly of octarhenium-based neutral luminescent rectangular prisms.

Self-assembly of rhenium-based nanoscale rectangular prismatic boxes has been achieved in quantitative conversion. The fac-rhenium corner provided three mutually perpendicular coordination sites and served as a good candidate for the construction of 3-D boxes. These are the first Re-based, neutral, luminescent prisms of M(8)L(2)L'(8) type that has been characterized crystallographically. Their luminescent properties and molecular recognition capabilities make these molecular prisms interesting supramolecules.