Combining multiple stressors unexpectedly blocks bacterial migration and growth.

In nature, organisms experience combinations of stressors. However, laboratory studies typically simplify reality and focus on the effects of an individual stressor. Here, we use a microfluidic approach to simultaneously provide a physical stressor (shear flow) and a chemical stressor (H 2 O 2 ) to the human pathogen Pseudomonas aeruginosa . By treating cells with levels of flow and H 2 O 2 that commonly co-occur in nature, we discover that previous reports significantly overestimate the H 2 O 2 levels required to block bacterial growth. Specifically, we establish that flow increases H 2 O 2 effectiveness 50-fold, explaining why previous studies lacking flow required much higher concentrations. Using natural H 2 O 2 levels, we identify the core H 2 O 2 regulon, characterize OxyR-mediated dynamic regulation, and dissect the redundant roles of multiple H 2 O 2 scavenging systems. By examining single-cell behavior, we serendipitously discover that the combined effects of H 2 O 2 and flow block pilus-driven surface migration. Thus, our results counter previous studies and reveal that natural levels of H 2 O 2 and flow synergize to restrict bacterial colonization and survival. By studying two stressors at once, our research highlights the limitations of oversimplifying nature and demonstrates that physical and chemical stress can combine to yield unpredictable effects.

Fluid flow overcomes antimicrobial resistance by boosting delivery.

Antimicrobial resistance is an emerging global threat to humanity. As resistance outpaces development, new perspectives are required. For decades, scientists have prioritized chemical optimization, while largely ignoring the physical process of delivery. Here, we used biophysical simulations and microfluidic experiments to explore how fluid flow delivers antimicrobials into communities of the highly resistant pathogen Pseudomonas aeruginosa . We discover that increasing flow overcomes bacterial resistance towards three chemically distinct antimicrobials: hydrogen peroxide, gentamicin, and carbenicillin. Without flow, resistant P. aeruginosa cells generate local zones of depletion by neutralizing all three antimicrobials through degradation or chemical modification. As flow increases, delivery overwhelms neutralization, allowing antimicrobials to regain effectiveness against resistant bacteria. Additionally, we discover that cells on the edge of a community shield internal cells, and cell-cell shielding is abolished in higher flow regimes. Collectively, our quantitative experiments reveal the unexpected result that physical flow and chemical dosage are equally important to antimicrobial effectiveness. Thus, our results should inspire the incorporation of flow into the discovery, development, and implementation of antimicrobials, and could represent a new strategy to combat antimicrobial resistance.

Healthcare Cost of Cochlear Implantation in India.

Making evidence-based policy decisions is challenging when there is a lack of information, especially when deciding provider payment rates for publicly funded health insurance plans. Therefore, the goal of this study was to estimate the cost of a cochlear implant operation in a tertiary care setting in India. We also looked at the patients' out-of-pocket (OOP) expenses for the cochlear implant surgery. From the perspectives of the patients and the healthcare systems, we assessed the financial costs of the cochlear implantation procedure. A bottom-up pricing model was used to assess the cost that the healthcare system would bear for a cochlear implant procedure. Information on all the resources (both capital and ongoing) required to offer cochlear implantation services for hearing loss was gathered over the course of a year. 120 individuals with hearing loss who had cochlear implantation surgery disclosed their out-of-pocket (OOP) costs, which included both direct medical and non-medical expenses. All costs for the budgetary year 2018-2019 were anticipated. The unit health system spent ₹ 151($2), ₹ 578($7.34) and ₹ 37,449($478) on ear exams, audiological evaluations, and cochlear implant surgeries, respectively. Per bed-day in the otolaryngology ward, hospitalization cost ₹ 202($2.6), or ₹ 1211($15.5). The estimated average out-of-pocket cost for a cochlear implant operation was ₹ 682,230($8710). Our research can be used to establish package rates for publicly funded insurance plans in India, plan the growth of public sector hearing care services, and do cost-effectiveness assessments on various hearing care models. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04389-7.

Molecular appraisal of Giardia intestinalis from Western India: A prospective observational study.

Background: Giardia intestinalis is an intestinal protozoan which commonly causes parasitic gastroenteritis globally. It is a species complex consisting of at least eight assemblages (genotypes). In India, Giardia is mostly underreported and missed in asymptomatic cases. Aim: The aim of this study was to genotype the G. intestinalis isolates from stool samples of patients at a tertiary care center in Rajasthan, India, and to clinically correlate it. Methods: This prospective pilot cross-sectional study was conducted from 2019 to 2021 in a tertiary care center in western India. Patients who were microscopically positive for giardiasis were enrolled. DNA was extracted from their stool samples and amplified by polymerase chain reaction (PCR) using 4E1-HP as the target sequence. Anthropometric measurements and analysis were done for children by using Anthrocal application. Results: A total of 50 patients were enrolled. Diarrhea was present in 18 patients (36%). Among these, 6 were immunocompromised and had different comorbidities. Among the children <12 years of age, 55.17% (n = 16/29) were stunted (<-2 S.D.), and among <5 years, 44.4% (n = 4/9) showed wasting (<-2 S.D.). A PCR product corresponding to assemblage B of G. intestinalis was amplified in 47 stool specimens. Only three stool samples were negative for both assemblages A and B and posed an interesting enigma. Conclusion: In this study, a predominance of assemblage B of G. intestinalis was detected in 94% of the isolates. Furthermore, the possibility of zoonotic transmission could not be ruled out.

Progress in the design of portable colorimetric chemical sensing devices.

The need for precise determination of heavy metals, anions, biomolecules, pesticides, drugs, and other substances is vital across clinical, environmental, and food safety domains. Recent years have seen significant progress in portable colorimetric chemical sensing devices, revolutionizing on-the-spot analysis. This review offers a comprehensive overview of these advancements, covering handheld colorimetry, RGB-based colorimetry, paper-based colorimetry, and wearable colorimetry devices. It explores the underlying principles, functional materials (chromophoric reagents/dyes and nanoparticles), detection mechanisms, and their applications in environmental monitoring, clinical care, and food safety. Noble metal nanoparticles (NPs) have arisen as promising substitutes in the realm of sensing materials. They display notable advantages, including heightened sensitivity, the ability to fine-tune their plasmonic characteristics for improved selectivity, and the capacity to induce visible color changes, and simplifying detection. Integration of NPs fabricated paper device with smartphones and wearables facilitates reagent-free, cost-effective, and portable colorimetric sensing, enabling real-time analysis and remote monitoring.

Subcutaneous mycosis caused by filamentous basidiomycete Megasporoporia setulosa-first report of human infection.

Filamentous basidiomycetes are an emerging cause of human infection in tropical and subtropical regions. We report a case of subcutaneous infection caused by the shelf fungus, Megasporoporia setulosa, in an immunocompetent male. This is also the first report of human infection caused by this filamentous basidiomycete. Identification of the fungus could only be achieved by sequencing the ITS and LSU regions of rDNA. The patient recovered following surgery and treatment with amphotericin B and oral itraconazole. This report underscores the cross-kingdom pathogenicity of plant fungi and the importance of molecular tools for definitive identification of nonsporulating fungal species.

Prediction of complications of pre-eclampsia using the fullPIERS high risk predictive model.

OBJECTIVE: To determine the predicted probability percentage of complications in women with pre-eclampsia using the Pre-eclampsia Integrated Estimate of Risk (fullPIERS) model within the first 24 h after admission and assess the model's predictive value for complications of pre-eclampsia. METHODS: This was a prospective cohort study in which the fullPIERS model was applied to 256 pregnant women with pre-eclampsia within the first 24 h after admission. These women were then followed for 48 h to 7 days for maternal and fetal complications. Reciever operating characteristics (ROC) curves were generated to assess the performance of the fullPIERS model for adverse outcomes of pre-eclampsia. RESULTS: Of the 256 women enrolled in the study, 101 women (39.5%) developed maternal complications, 120 women (46.9%) developed fetal complications, and 159 women (62.1%) developed both. With an area under the ROC curve of 0.843 (95% confidence interval 0.789-0.897), the fullPIERS model had good discriminating ability to predict complications at any time point between 48 h and 7 days after admission. The sensitivity and specificity of the model at a ≥5.9% cut-off value for predicting adverse maternal outcomes were 60% and 97%, respectively; they were 44% and 96%, respectively, for predicting combined fetomaternal complications with a cut-off value of 4.9%. CONCLUSIONS: The fullPIERS model performs reasonably well in predicting adverse maternal and fetal outcomes in women with pre-eclampsia.

Development of Phonemically Balanced Passage, Oral Passage, and Nasal Passage in the Punjabi Language.

The primary aim of the study was to develop phonemically balanced passage, Oral passage and Nasal passage in Punjabi language. Development of the passage: The words in the passage were chosen to represent the way sounds are distributed in spoken Punjabi language, and the relative phonemic distribution of each word inside each paragraph matched how frequently each sound occurs in Punjabi. The paragraph was constructed using words that were rated as extremely familiar and familiar. The developed passages were given to five speech-language pathologists for the purpose of content validation. 100 people with normal hearing between the ages of 18 and 25 were enrolled in the study (50 female and 50 male). Each subject's nasalence was measured using a Nasometer. The individuals were given passages written in Punjabi to read, and their nasalence scores for each text were recorded. The nasalance mean for Punjabi phonemically balanced passage was 36.41 ± 4.61% and 38.57 ± 4.22% in male and female subjects. The Punjabi oral passage mean were 27.36 ± 4.14% and 28.46 ± 4.01% in male and female subjects. The means for Punjabi nasal passage were 46.15 ± 4.09% in male subjects and 47.04 ± 4.91% in the female subjects. The Intraclass correlation coefficient for Female and male subjects for the Punjabi Phonemically balanced passage, Punjabi oral passage, Punjabi nasal passage were 0.904, 0.945; 0.807, 0.909, and 0.956, 0.913 respectively. The developed passages have good test retest reliability and their normative scores can be used for assessment of different resonance disorders.

In vitro chemo-preventive efficacy of synthetic progestin Norethindrone in human epithelial ovarian cancer.

Progestin-only based oral contraceptives are majorly used as 'minipill' to prevent unintended pregnancy and treat conditions like polycystic ovary syndrome, hirsutism, and acne. However, the dearth of literature has constrained our comprehension of the exogenous progestin in relation to ovarian cancer progression. Therefore, the aim of the present study was to evaluate the chemo-preventive potential of synthetic progestin Norethindrone (NET) in epithelial ovarian cancer in vitro. Briefly, SKOV3 cells were treated with 1, 10 and 100 µM concentrations of NET for seven days period. The assays for cell viability, wound-healing, cell cycle progression, detection of reactive oxygen species (ROS) and apoptosis were executed to illustrate the protective role of NET. To further clarify the underlying process, quantitative analysis of mRNA levels of oncogenes linked to angiogenesis, inflammation, proliferation, and metastasis (VEGF, HIF-1α, COX-2, and PGRMC1) and tumour suppressor (TP53) genes was conducted. Our study revealed that NET treatment significantly reduced SKOV3 cell growth by inducing cell cycle arrest at G2/M phase, elevating ROS levels, triggering cell death via apoptosis and necrosis, and inhibiting cell migration in a dose-dependent manner. Notably, NET also upregulated TP53 expression while concurrently downregulating VEGF, HIF-1α, COX-2, and PGRMC1 expression. Our results demonstrated that the chemo-preventive effect of Norethindrone may originate from the interaction of genes which exert a protective effect against ovarian carcinogenesis. The current findings also support further investigation, which may lead to changes in prescription practices or health-related advice for women.

Co+2, Ni+2 and Cu+2 incorporated Bi2O3 nano photocatalysts: Synthesis, DFT analysis of band gap modification, adsorption and photodegradation analysis of rhodamine B and Triclopyr.

This study deals with the fabrication of metal ion (M = Co+2, Ni+2, and Cu+2) doped- Bi2O3 photocatalysts by solution combustion method. All the synthesized materials were characterized and analysed with the help of XRD, FESEM, EDX, HRTEM, UVDRS, Zeta potential, PL, and LCMS techniques for the structural, morphological, surface charge, optical and degradation pathways characteristics. Synthesized compounds were used for the decontamination (adsorption and degradation) of two organic pollutants namely Rhodamine B and Triclopyr. Adsorption aspects of the pollutants were studied in terms of different isotherm, kinetic and thermodynamic models. Adsorption phenomenon was best fitted with the Freundlich (R2 = 0.992) and Langmuir isotherm (R2 = 0.999) models along with pseudo second order model of kinetics for RhB and TC, respectively. Moreover, the thermodynamic parameters indicated exothermic and endothermic adsorption (ΔH ° (-7.19 kJ/mol) for RhB) and (ΔH ° (52.335 kJ/mol) for TC), respectively. Evaluated negative values of ΔG ° indicated spontaneous adsorption with most favourable at 298 K and 318 K for both the pollutants (RhB and TC) respectively. Modification with metal ions significantly improved the removal efficiency of pure Bi2O3 photocatalyst and followed the trend Co+2/Bi2O3 > Ni+2/Bi2O3 > Cu+2/Bi2O3 > Bi2O3. DFT calculations demonstrate that amongst the doped materials, only Co+2/Bi2O3 is characterized by an indirect band gap; which exhibited efficacious photocatalytic activity. Besides, the highest degradation efficiency was obtained in the case of Co+2/Bi2O3 (2 mol %); being 99.80% for RhB in 30 min and 98.50% for TC in 60 min, respectively. The doped nanostructures lead to higher absorption of visible light and more separation of light-induced charged carriers. Effect of pH of the reaction medium and role of reactive oxygen species was also examined. Finally, a probable mechanism of charge transfer and degradation of the pollutants was also presented.

Perfusion CT imaging as a diagnostic and prognostic tool for dementia: prospective case-control study.

BACKGROUND: As functional changes precede structural changes in dementia, we aimed to elucidate changes on cerebral perfusion CT (PCT) for early diagnosis of dementia; and to differentiate Alzheimer's disease (AD) from vascular dementia (VaD). We also aimed to study correlation between Montreal Cognitive Assessment (MOCA) score and PCT parameters. METHODS: We conducted a prospective case-control study enrolling 25 dementia patients (15 cases of VaD, 10 cases of AD) and 25 age-matched controls. PCT was performed on a 256-slice CT scanner. Using perfusion software, colour maps were generated for cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time and time-to-peak. These colour maps were first visually inspected for any abnormalities. Subsequently, quantitative assessment of perfusion parameters was done using symmetrical freehand region of interests drawn in bilateral frontal, temporal, parietal regions, basal ganglia and hippocampi. RESULTS: Strategic infarcts were present in 93.3% cases and white matter ischaemic changes in 100% cases of VaD. A global reduction in CBF and CBV was also observed in cases of VaD; whereas these parameters were significantly lower mainly in temporoparietal regions and hippocampi of patients with AD. There was significant positive correlation between MOCA score and various perfusion parameters in both forms of dementia. CONCLUSION: PCT is a reliable imaging modality for early diagnosis of dementia and in differentiating VaD from AD. As perfusion parameters show positive correlation with MOCA score, they could be used as a surrogate marker of cognitive status in the follow-up of patients with dementia.

Recent advances in synthesis, structural properties, and regulation of nickel sulfide-based heterostructures for environmental water remediation: an insight review.

Heterostructured nanomaterials exhibit pronounced potential in environmental science, including the water purification, pollutant monitoring, and environmental remediation. Especially, their application through advanced oxidation processes has been found capable and adaptable in waste water treatment. In semiconductor photocatalysts, metal sulfides are the leading materials. However, for further modifications, the progresses on specific materials need to be overviewed. Among metal sulfides, nickel sulfides are the emerging semiconductors due to relatively narrow band gaps, high thermal and chemical stability, and cost effectiveness. The aim of the present review is to conduct a thorough analysis and summary of recent progress in the application of nickel sulfide-based heterostructures in water decontamination. Initially, the review introduces the emerging needs of the materials for environment following the characteristics features of metal sulfides with emphasis on nickel sulfides. Subsequently, synthesis strategies and structural properties of nickel sulfide (NiS and NiS2)-based photocatalysts are discussed. Herein, controlled synthesis procedures to influence their active structure, compositions, shape, and size for the enhanced photocatalytic performances are also considered. Furthermore, there is discussion on heterostructures formed by metal modification, metal oxides, and carbon hybridized nanocomposites. In the continuation, the modified characteristics are investigated which favors the photocatalytic processes for degradation of organic contaminations in water. The overall study highlights significant improvements in degradation efficiency of hetero-interfaced NiS and NiS2 photocatalysts towards organics that are comparable to expensive noble-metal photocatalysts. Finally, we also added a little on prospects for future advancement of nickel sulfide-based photocatalysts for applications in sustainable environmental remediation.

Shear rate sensitizes bacterial pathogens to H2O2 stress.

Cells regularly experience fluid flow in natural systems. However, most experimental systems rely on batch cell culture and fail to consider the effect of flow-driven dynamics on cell physiology. Using microfluidics and single-cell imaging, we discover that the interplay of physical shear rate (a measure of fluid flow) and chemical stress trigger a transcriptional response in the human pathogen Pseudomonas aeruginosa. In batch cell culture, cells protect themselves by quickly scavenging the ubiquitous chemical stressor hydrogen peroxide (H2O2) from the media. In microfluidic conditions, we observe that cell scavenging generates spatial gradients of H2O2. High shear rates replenish H2O2, abolish gradients, and generate a stress response. Combining mathematical simulations and biophysical experiments, we find that flow triggers an effect like "wind-chill" that sensitizes cells to H2O2 concentrations 100 to 1,000 times lower than traditionally studied in batch cell culture. Surprisingly, the shear rate and H2O2 concentration required to generate a transcriptional response closely match their respective values in the human bloodstream. Thus, our results explain a long-standing discrepancy between H2O2 levels in experimental and host environments. Finally, we demonstrate that the shear rate and H2O2 concentration found in the human bloodstream trigger gene expression in the blood-relevant human pathogen Staphylococcus aureus, suggesting that flow sensitizes bacteria to chemical stress in natural environments.

Bacteria in Fluid Flow.

Bacteria thrive in environments rich in fluid flow, such as the gastrointestinal tract, bloodstream, aquatic systems, and the urinary tract. Despite the importance of flow, how flow affects bacterial life is underappreciated. In recent years, the combination of approaches from biology, physics, and engineering has led to a deeper understanding of how bacteria interact with flow. Here, we highlight the wide range of bacterial responses to flow, including changes in surface adhesion, motility, surface colonization, quorum sensing, virulence factor production, and gene expression. To emphasize the diversity of flow responses, we focus our review on how flow affects four ecologically distinct bacterial species: Escherichia coli, Staphylococcus aureus, Caulobacter crescentus, and Pseudomonas aeruginosa. Additionally, we present experimental approaches to precisely study bacteria in flow, discuss how only some flow responses are triggered by shear force, and provide perspective on flow-sensitive bacterial signaling.

Acridine: A Scaffold for the Development of Drugs for Alzheimer's Disease.

Alzheimer's disease (AD) is drawing scientists' consideration, being one of the gravest diseases mankind will have to battle against in the near future. The number of people with AD is expected to triple in the next 40 years. It is a most common age-related multifactorial neurodegenerative disease and characterized by two histopathological hallmarks; the formation of senile plaques composed of the amyloid-ß (Aß) peptide and neurofibrillary tangles composed of hyperphosphorylated tau protein. Discovery and development of rationally designed multi-targeted ligands for the management of AD could be more beneficial than classical single targeted molecules. Acridine, a heterocyclic nucleus is a sole moiety in various existing drug molecules such as quinacrine (antimalarial), acriflavine and proflavine (antiseptics), ethacridine (abortifacient), amsacrine and nitracine (anticancer) and tacrine (anti-Alzheimer). It is proposed that acridine may combat the AD by acting on several targets like acetylcholinesterase (AChE), butyrylcholinesterase (BuChE), dual specificity tyrosine kinase 1A (Dyrk 1A), amyloid and prion protein (PrPC) etc. involved in its pathogenesis. The main aim of this compilation is to review the most promising therapeutic developments within the vast research area dealing with acridine derivatives. Further research is required to evaluate the effectiveness of the acridine derivatives with various substitutions in the treatment of AD. In conclusion, our review will suggest the potentiality of the versatile acridine framework for drug designing and developing novel multi-target inhibitors for the Alzheimer's disease.

A pentavalent approach for the evaluation of traumatic brachial plexopathy on MRI: correlation of macropattern and micropattern.

Macropattern analysis of traumatic brachial plexopathy (TBP) by Magnetic Resonance Imaging (MRI) encompasses localization of injured segments and determination of the severity of injury. The micropattern analysis implies the correlation of the MRI features of TBP with Sunderland's grading of the nerve injury, thereby guiding the management protocol. This review article presents a simplified novel pentavalent approach for the radiological anatomy of brachial plexus, MRI acquisition protocol for the evaluation of brachial plexus, cardinal imaging signs of TBP, and their correlation with Sunderland's microanatomical grading.

Influence of speech aid prosthesis with speech therapy on speech outcomes in adult patients with persisting velopharyngeal insufficiency: A retrospective analysis.

STATEMENT OF PROBLEM: Prosthetic intervention with a speech aid prosthesis (SAP) along with speech therapy has been reported to improve speech outcomes in patients with persisting velopharyngeal insufficiency (VPI). However, little is known regarding the impact of this treatment on different speech parameters over time in adult patients with VPI. PURPOSE: The purpose of this retrospective study was to evaluate the change in speech parameters after rehabilitation with an SAP and speech therapy in adult patients with VPI using subjective and objective tests. MATERIAL AND METHODS: Patients above 16 years of age who had received prosthetic treatment for VPI and had complete speech assessment records between 2017 and 2020 were included in the analysis. After completion of the prosthetic treatment, speech therapy comprising 2 sessions per week of 45 minutes was provided by a speech pathologist. Speech evaluation was performed using tests that included speech intelligibility calculation, nasal pinch test, audible nasal air emissions, acoustic analysis, and the nasalance check. Assessments were done at 4 time intervals: T0: without an SAP; T1: 1 week with an SAP; T2: 1 month with an SAP; and T3: 3 months with an SAP. A descriptive analysis was followed by a comparison between groups using the Friedman test for subjective assessments and repeated measures ANOVA for objective tests (α=.05). RESULTS: Of 10 individuals who had received an SAP, 5 participants, 2 men and 3 women with a mean age of 38 years were included in the analysis. Statistically significant improvement in mean scores was observed from T0 to T3 concerning speech intelligibility (P<.001), hypernasality (P<.001), audible nasal air emission (P<.001), mean fundamental frequency (P=.034), shimmer percentage (P=.004), and nasalance (P=.004). Improvement in jitter percentage was not statistically significant (P=.218). CONCLUSIONS: An SAP along with speech therapy should be considered as a conservative and effective treatment option for addressing speech issues in adult patients with VPI.

First report of human infection caused by Curvularia warraberensis, manifesting as invasive sinusitis with intracranial involvement.

Curvularia species are saprophytic dematiaceous fungi commonly isolated from environmental sources. Most often, they are responsible for allergic fungal rhinosinusitis, an intense, allergic inflammatory sinus disease in immunocompetent individuals. Though invasive infections are rare and more commonly observed in immunocompromised patients, recent reports indicate an increasing trend of invasive sinusitis caused by Curvularia species in immunocompetent hosts. Over the past few years, new species of the genus Curvularia are increasingly being recognized as human pathogens. Here, we report the first human infection caused by Curvularia warraberensis, a cryptic species of Curvularia primarily described as an endophyte in Australian grasses. The 33-year-old female presented with chronic invasive sinusitis of the sphenoid and ethmoid sinuses that progressed to involve the pituitary gland, mid-brain, the facial-vestibulocochlear nerve complex, and basilar artery. The patient underwent endoscopic sinus surgery. Histopathology, microscopic examination and culture of biopsy tissues revealed a dematiaceous fungus that was identified as C. warraberensis, based on sequencing the internal transcribed spacer (ITS) and large subunit (LSU) regions of ribosomal DNA. Antifungal susceptibility testing (AFST) showed low minimum inhibitory concentrations (MICs) for amphotericin B (1 µg/mL), itraconazole (0.25 µg/mL) and posaconazole (0.125 µg/mL). Accurate identification and AFST are crucial for making treatment decisions as some Curvularia species demonstrate variable susceptibility to antifungal agents. The patient died despite combined surgical and medical intervention owing to late presentation and delay in initiating antifungal therapy. A high index of suspicion together with an early diagnosis and aggressive treatment may improve the outcome in such cases.

First case of neonatal fungemia caused by Aureobasidium melanogenum.

Aureobasidium melanogenum is a saprophytic, dematiaceous, yeast-like fungus rarely implicated in human infections. Here, we report the first case of A. melanogenum fungemia in a 30-week-old preterm, very low birth weight neonate born to a primigravida with history of gestational diabetes, pregnancy induced hypertension and oligohydramnios. The baby developed respiratory distress, hypotension, bradycardia, coagulopathy and septic shock shortly after birth, and eventually succumbed to multiple organ dysfunction syndrome on day 9 of life. Paired blood culture showed growth of a dematiaceous yeast-like fungus which was identified as A. melanogenum by rDNA internal transcribed spacer (ITS) sequencing. Antifungal susceptibility testing of the isolate showed high minimum inhibitory concentration of fluconazole (32 µg/mL), indicating resistance. Diagnosis of A. melanogenum fungemia is difficult as it is easily confused with Candida species in Gram stained smears and similar colony morphology during the initial stages of growth. Also, the conventional diagnostic methods, such as VITEK 2 and MALDI-TOF MS are unreliable for identification of this pathogen. Accurate identification using molecular techniques is crucial for making treatment decisions as A. melanogenum shows substantial antifungal resistance. Clinicians should be aware that yeast-like cells in blood culture are not only indicative of Candida species, but also rare pathogens like A. melanogenum and should exercise caution while starting fluconazole therapy. At present, there are no established susceptibility breakpoints for Aureobasidium spp. Further studies are needed to determine the optimal treatment for such infections.

Mucormycosis caused by Apophysomyces species: An experience from a tertiary care hospital in Western India and systematic review of global cases.

Apophysomyces species are an emerging cause of mucormycosis in several regions of the world, primarily affecting immunocompetent individuals. The present study addresses the global epidemiology, clinical presentation, management and outcome of mucormycosis caused by Apophysomyces spp. The study included patients diagnosed with Apophysomyces infection at our hospital between March 2019 and August 2020. In addition, cases published in PubMed and Google Scholar from inception to July 2022 were systematically searched and analysed. Only proven and probable cases that meet the eligibility criteria were included. The Indian cases were compared with those from other countries, and the results were analysed by descriptive statistics. In total, six cases of mucormycosis due to Apophysomyces spp. were diagnosed at our hospital, with additional 250 cases identified through literature search. The main underlying diseases were diabetes mellitus (24%), malignancy (3.2%) and chronic kidney disease (2.8%). The major predisposing factor was trauma (55.6%). Necrotizing fasciitis was the most common (63.2%) clinical presentation. Healthcare-associated mucormycosis accounted for 10.4% of the cases. Globally, A. elegans was the most common species (48.8%), whereas A. variabilis was predominant (86.2%) in India. Surgery was performed in 83.5% of patients. Among those treated with antifungal agents, 98% received amphotericin B and 8.1% received posaconazole. Inappropriate antifungal usage was observed in 12.7%. The overall mortality was 42.3%. A combined medical and surgical management was associated with higher survival. Our study highlights the knowledge gap among physicians regarding this infection. A timely diagnosis and aggressive management can improve the outcomes in such cases.