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Background: Aspergillus is the most frequently occurring fungal infection in immunocompromised patients with a high mortality rate. Invasive pulmonary aspergillosis is the most serious entity on the spectrum of pulmonary aspergillosis. Limited studies on the occurrence of pulmonary aspergillosis from this geographical area prompted us to carry out this study. Materials and Methods: This hospital-based cross-sectional observational study was carried out in the Postgraduate Department of Microbiology of a tertiary care medical teaching hospital in western Uttar Pradesh for one year. A total of 1032 respiratory samples were subjected for isolation and identification of fungal pathogens by direct microscopic examination (KOH mount) and culture on Sabouraud dextrose agar. Results: The isolation rate of pulmonary aspergilli was 6.97%. The majority of the respiratory samples received were sputum 900 (87.2%) followed by bronchoalveolar lavage fluid 132 (12.7%). The pulmonary pathology was predominantly seen in the age group of 41–50 years (25%). Male patients (69%) were predominant. The majority of the samples (50%) were from the respiratory medicine ward followed by the respiratory medicine ICU (25%). Aspergillus fumigatus (58%) was the predominant species isolated followed by Aspergillus flavus (25%). Conclusion: Isolation of Aspergillus species from patients of pulmonary pathology needs to be correlated clinically to rule out colonization as they may need proper antifungal treatment. Indiscriminate use of antifungals may lead to the emergence of antifungal drug resistance.

Objective Linezolid is an important antimicrobial agent which is active against multidrug-resistant Gram-positive cocci. Methicillin-resistant Staphylococcus aureus (MRSA) cause life-threatening infection, with narrow therapeutic options including linezolid and vancomycin. The presence of cfr (chloramphenicol–florfenicol resistance) and optrA (oxazolidinone phenicol resistance) gene plays a crucial role in linezolid resistance. Materials and Methods A total of 199 clinical isolates were confirmed as S. aureus using GP ID p628 card, followed by antibiotic susceptibility testing using GPAST cards in the Vitek 2 compact system (Biomerieux, France) to determine minimum inhibitory concentration (MIC) of linezolid. An MIC value of ≥8 μg/ml was taken as resistant for linezolid. Furthermore, the presence of cfr and optrA gene was looked for in the clinical isolates of linezolid resistant S. aureus (LRSA). Results LRSA was isolated in 2.5% of clinical samples. All LRSA were also MRSA, and all of them were recovered from indoor samples. The LRSA were 100% susceptible to vancomycin. cfr gene could be detected in 40% of the isolates. However, all our isolates of LRSA were negative for optrA gene. Conclusions Emergence of linezolid resistance in clinical isolates of S. aureus is a matter of therapeutic concern which alerts toward judicious use of linezolid in clinical practice. The presence of cfr gene is the most common mechanism of resistance to linezolid.

Ewingella americana is a Gram-negative rod belonging to the order Enterobacterales and comprises only species of the genus Ewingella. The pathogenic potential of E. americana in humans was not clearly understood previously. E. americana has rarely been reported globally and is considered opportunistic pathogen among immunocompromised individuals. We reported a case of catheter-associated urinary tract infection due to E. americana from a tertiary care medical teaching institute from Uttar Pradesh, India. E. Americana was identified by VITEK-2 compact automated system which was reconfirmed by conventional biochemical tests. This multidrug-resistant pathogen was found susceptible only against tigecycline, and intermediate susceptibility was observed against amikacin.

Taxus wallichiana Zucc. (Himalayan yew) has been well-documented for containing therapeutically significant active ingredients. Its bark contains pharmaceutically important compounds i.e., taxol and its derivatives which are well known for their anticancer potential. However, T. wallichiana has received limited attention for its equally significant antimicrobial properties. Keeping this background in view, T. wallichiana was selected for the detailed investigation of antimicrobial activities, and isolation and characterization of secondary metabolites responsible for antimicrobial activity in different plant parts i.e., needle, bark, and stem extracts. In plate-based bioassays, plants exhibited antimicrobial action against the three main categories of microorganisms (fungi, bacteria, and actinobacteria). Based on the preliminary antimicrobial study, methanol and ethyl acetate extracts, were selected for further experiments. The bioautographic technique was used for identification, and the mobile phase was optimized with the help of a selectivity triangle. After continuous column and thin-layer chromatography, fractions were identified as having good antifungal, antibacterial, and antiactinobacterial activity. These fractions were selected for further characterization using techniques like GC-MS/LC-MS, and FTIR. These analyses support the identification of several fatty acids, including arachidic acid, behenic acid, palmitic acid, and stearic acid; vitamins (nicotinamide); alkaloids (cinchonine, timolol); amino benzamides (procainamide); carbocyclic sugars (myoinositol); and alkane hydrocarbons (hexadecane), which have antimicrobial activity in T. wallichiana needles. The information gathered from this study will help modern medicine make new drug discoveries that combine different active ingredients from medicinal plants to treat a wide range of ailments.

Background: Staphylococcus haemolyticus is a clinically significant Coagulase Negative Staphylococci (CoNS) accountable for various infections and is often multi-drug resistant along with resistance to linezolid. Aim and Objectives: This study was carried out to detect the presence of cfr and optrA gene in clinical isolates of linezolid resistant S. haemolyticus in a tertiary care hospital. Material and Methods: A total of 227 clinical isolates of S. haemolyticus recovered from various clinical samples were tested to determine susceptibility to linezolid by phenotypic method. Further, the presence of cfr & optrA gene was looked for, in clinical isolates of S. haemolyticus. Results: S. haemolyticus was isolated predominantly from inpatient department mainly from blood culture (85%). Linezolid resistance was confirmed in 9.2% isolates of S. haemolyticus phenotypically and they were also methicillin resistant. On genotypic characterization, cfr gene could be detected in 7.04% the isolates. However, all the isolates were negative for optrA gene. Conclusion: Emergence of resistance to linezolid in S. haemolyticus was reported for the first time. The presence of cfr gene is the most common mechanism of resistance to linezolid. Correct identification of these isolates and adherence to strict infection control protocols will help in better clinical outcomes.

Introduction: Genitourinary Tuberculosis (GUTB) remains an important cause of infertility in India. The clinical manifestations of GUTB are non specific, resulting in delayed diagnosis and initiation of Anti Tubercular Treatment (ATT). This delay can lead to various complications such as kidney dysfunction, ureteral strictures, and a shrunken bladder. Aim: To evaluate the diagnostic importance of Real Time Polymerase Chain Reaction (RT-PCR) targeting the mpb64 gene for the rapid and accurate diagnosis of GUTB. Materials and Methods: A cross-sectional hospital-based observational study was conducted in the Department of Microbiology at Subharti Medical College and associated Chhatrapati Shivaji Subharti Hospital in Meerut, Western Uttar Pradesh, India. The study was conducted over a three-year period, from January 2019 to December 2021. A total of 200 genitourinary samples were collected from female patients with clinical suspicion of Tuberculosis (TB) and subjected to direct microscopy, mycobacterial culture by BacT/Alert 3D (Biomerieux, France), and RT-PCR targeting the mpb64 gene (Qiagen). Demographic details were recorded in a predesigned proforma. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) software version 26.0 (IBM Corp., Armonk, NY, USA). The p-value was calculated using the Chi-square test. Results: RT-PCR showed a higher positivity rate of 56 (28.9%) compared to 47 (24.2%) by culture. Acid Fast Bacilli (AFB) microscopy was the least sensitive, detecting only 7 (3.6%) cases. When comparing the results of RT-PCR with conventional methods, RT-PCR had a sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of 91.9%, 99.4%, 85.1%, and 93.8%, respectively. Conclusion: RT-PCR targeting the mpb64 gene is a specific and effective additional test that aids in the early and accurate diagnosis of Extrapulmonary Tuberculosis (EPTB), including GUTB, compared to conventional methods. Early diagnosis facilitates timely initiation of ATT, leading to better clinical outcomes.

Acinetobacter are Gram-negative coccobacilli comprising of Acinetobacter baumannii and Acinetobacter lwoffii as commonly isolated species of the genus Acinetobacter from clinical specimens. The other species of the genus Acinetobacter are rarely isolated from clinical specimens and usually considered as environmental contaminants. Acinetobacter junii has rarely been reported globally causing opportunistic infections in immunocompromised individuals. We reported a series of four clinical cases due to Acinetobacter junii infection in a tertiary care teaching institute from Uttar Pradesh, India. Among these reported cases first case was peritonitis, second and third cases were catheter associated urinary tract infection and fourth case was ventilator associated pneumonia. All these cases were reported among immunocompromised individuals and Acinetobacter junii was identified by VITEK-2 Compact automated system which was further reconfirmed by conventional biochemical tests. These isolates were found to be susceptible against most of the antimicrobials.

Background: Candidemia is one of the common health care associated Blood Stream Infections (BSI). Frequency of isolation of various Candida species causing candidemia and their antifungal drug resistance trends in a health care setting can help in timely institution of appropriate empirical antifungal treatment. Aim and Objectives: To observe the species distribution of various Candida species isolated from suspected cases of BSI and their antifungal susceptibility pattern in a tertiary care hospital from western Uttar Pradesh. This study was conducted to speciate Candida isolates isolated from blood culture samples and their antifungal susceptibility testing. Material and Methods: This study was conducted in the Department of Microbiology, Subharti Medical College and associated Chhatrapati Shivaji Subharti Hospital, Meerut for a period of one year. Blood culture was done by BacT/Alert automated blood culture system from BioMerieux, France. Candida isolates recovered from blood culture were further processed for speciation using conventional morphological and biochemical characteristics and antifungal susceptibility testing by Kirby Bauer disk diffusion method. Results: Out of total 70 Candida isolates isolated during the study period C. tropicalis was the predominant isolate accounting for 34.28% followed by C. parapsilosis. The occurrence of candidemia was higher in Intensive Care Units (ICUs) patients (70.83%). Antifungal drug voriconazole was found to be sensitive against all the Candida isolates. Conclusion: Mycological shift towards the isolation of NAC species indicates a changing trend and changing antifungal drug resistance profile accordingly have to be considered before initiation of empirical antifungal treatment.

Aim: The aim of the study is to evaluate and compare the effect of access cavity designs on the polymicrobial biofilm disinfection of root canal system. Methods: One hundred and twenty molar teeth were selected and randomly divided into four groups (n = 30) on the basis of access cavity design: traditional access cavity (TEC), contracted access cavity (CAC), truss access cavity (TAC), and caries-driven access cavity (CDAC). After access preparation, the samples were contaminated for 2 weeks to grow polymicrobial mature biofilm. Microbial sampling from the root canals was performed with sterile paper points before and after instrumentation to determine the bacterial load. The bacterial reduction was counted as CFU/ml and analyzed statistically. Results: Both maxillary and mandibular molars with different cavity designs showed significant decreased in the number of Enterococcus faecalis, Staphylococcus aureus, and Candida albicans postinstrumentation. TEC group showed significantly higher microbial reduction for all tested microorganisms than TAC and CDAC groups (P < 0.05). However, insignificant difference (P > 0.05) was observed between TEC and CAC and TAC and CDAC. Conclusion: In both maxillary and mandibular molars, complete elimination of microbes (E. faecalis, C. albicans, and S. aureus) could not be achieved with any access cavity design. Highest microbial reduction was achieved with TEC and lowest in CDAC. Both TEC and CAC resulted in equal microbial reduction and were superior to TAC and CDAC.

The cold adapted microorganisms, psychrophiles/psychrotolerants, go through several modifications at cellular and biochemical levels to alleviate the influence of low temperature stress conditions. The low temperature environments depend on these cold adapted microorganisms for various ecological processes. The ability of the microorganisms to function in cold environments depends on the strategies directly associated with cell metabolism, physicochemical constrains, and stress factors. Pseudomonas is one among such group of microorganisms which is predominant in cold environments with a wide range of ecological and biotechnological applications. Bioformulations of Pseudomonas spp., possessing plant growth promotion and biocontrol abilities for application under low temperature environments, are well documented. Further, recent advances in high throughput sequencing provide essential information regarding the prevalence of Pseudomonas in rhizospheres and their role in plant health. Cold adapted species of Pseudomonas are also getting recognition for their potential in biodegradation and bioremediation of environmental contaminants. Production of enzymes and bioactive compounds (primarily as an adaptation mechanism) gives way to their applications in various industries. Exopolysaccharides and various biotechnologically important enzymes, produced by cold adapted species of Pseudomonas, are making their way in food, textiles, and pharmaceuticals. The present review, therefore, aims to summarize the functional versatility of Pseudomonas with particular reference to its peculiarities along with the ecological and biotechnological applications.

Rotavirus is a major cause of severe acute gastroenteritis in infants and young children worldwide. It is responsible for 40% of childhood hospitalization. It has been estimated that about 23% of diarrhoeal death occurs due to the rotavirus infection in India. To study the epidemiology of rotavirus infection in children less than 5 years of age at a tertiary care teaching hospital. A total of 240 stool samples were collected from children

Background: Hands are the most common vehicle for the transmission of pathogens within the healthcare environment. Hand hygiene is the leading measure for reducing healthcare-associated infections (HCAIs) and preventing the spread of antimicrobial resistance. Objective: An interventional study was carried out to evaluate the knowledge, attitude and practices of hand hygiene among third semester medical students. Materials and methods: A total of 152 medical students were evaluated using a pretest self-structured questionnaire to assess the knowledge, attitude and practices regarding hand hygiene. The students were trained by faculty of microbiology vigorously with the help of a lecture and demonstration on hand hygiene followed by hands-on training. The same group of students were then distributed the post-training questionnaire. The pre-training and post training data was analyzed and compared. Result: There was a significant improvement in knowledge, attitude and practice towards hand hygiene among students after intervention, as seen on comparison of results of post-test questionnaire from its pre-test counter-part because the doubts in the mind of the students got cleared in the education sessions. Conclusion: Targeting medical students and teaching them the good standard practices was fruitful as they were young, easy to mold and enthusiastic and above all they are the future doctors. Such educational intervention regarding hand hygiene will be carried out for each batch of medical students in future. Keywords: Hand hygiene, Medical students, Targeted educational intervention

The present study aims to investigate the effect of extraction method on the recovery of flavonoid glycosides, antimicrobials and antioxidants from Ginkgo leaves collected from six different locations in Uttarakhand, Indian Himalaya. Four extraction methods, namely maceration, reflux, shaker and soxhlet were considered, where reflux extracts showed higher antimicrobial antioxidant activity and higher content of flavonoid glycosides. The reference standards of Ginkgo flavonoid glycosides (quercetin, kaempferol and isorhamnetin) and crude extracts were tested for their antimicrobial activity against gram positive and gram negative bacteria and fungi following disc diffusion method and minimum inhibitory concentration (MIC). All the test microorganisms were observed to be inhibited significantly by Ginkgo flavonoids in plate based assays. Correlation coefficients exhibited the extent of contribution of flavonoid glycosides in antimicrobial activity and confirmed the reflux method as a potential method for extraction. Moreover, antioxidant activity as measured by DPPH assay was also found to be higher in reflux method. Significant variation (p

Myroidesis a nonfermentative, gram-negative rod shaped bacterium which is an emerging multidrug resistant pathogen causing many serious hospital acquired infections like Catheter Associated Urinary Tract Infection (CAUTI). The authors report a case series (four cases) of CAUTI caused by Myroides species which was resistant to all tested antibiotics (ticarcillin-clavulanic acid, piperacillin-tazobactam, ceftazidime, cefepime, aztreonam, cefoperazonesulbactam, imipenem, meropenem, amikacin, gentamycin ciprofloxacin, levofloxacin, colistin, tigecycline) and sensitive only to minocycline (minimum inhibitory concentration

Influence of drying temperature (30–50 °C) and relative humidity (RH: 30–80%) on moisture content, energy requirement and quality of Ginkgo biloba leaves with respect to chemical markers namely Ginkgolide A (GA) and Bilobalide (BB), and microbial load of dried materials has been analyzed. Leaves were dried in climate control chamber with varying temperature and relative humidity (RH). Total time required for attaining equilibrium was higher for low temperature at all the RH levels as well as for high RH at all the temperatures. Energy requirement was found to increase at high RH and low temperature. GA and BB concentration increased during drying in comparison to that in fresh material. Microbial load analyzed for dried samples was also found within the limit as prescribed in European Pharmacopeia under the category 3B. 40 °C temperature and 50 % RH with less drying duration was observed as suitable conditions for better recovery of BB and GA content, less microbial load and less energy consumption, during drying of G. biloba leaves.

With globalisation and growing health risks of synthetic colourants, search for pigments from natural sources has increased owing to their non-toxic nature. The present study highlights the bioprospection of natural pigment from a cold adapted fungal strain of Penicillium sp. (GBPI_P155), isolated from soil of Indian Himalayan region. The fungus produced insoluble and orange-coloured pigment in liquid medium with maximum production recorded in potato dextrose (PD) broth at 15°C and 3 pH, while maximum biomass was produced at 25°C and pH 3. While examining the effect of different mineral salts, and carbon and nitrogen sources on pigment production, maximum accumulation of pigment was recorded in PD broth supplemented with 2% maltose. Following production, extraction of pigment was performed using chloroform and characterised partially by UV/vis (λmax at 495 nm and a shoulder peak at 530 nm) and Fourier Transform Infrared (FT-IR) spectroscopy. Thin layer chromatography of chloroform extract resulted in separation of pigment in three fractions with Rf values 0.911, 0.852 and 0.808, which were further analysed using Liquid Chromatography Mass Spectrometry (LC/MS). The overall approach resulted in identification of pigment as a mixture of different derivatives of carotenoids. The extracted pigment also possessed antimicrobial activity against Gram-positive and Gram-negative bacteria and actinobacteria.

The hallmark of Polycythemia vera (PV) is the presence of JAK2V617F mutation and increased RBC mass. Chronic myelomonocytic leukemia (CMML) is defined as persistent blood absolute monocyte count (AMC) >/= 1 × 109/L for at least 3 months with myeloid cell dysplasia. Few cases of evolved CMML from PV have been described. We present a case of PV that progressed to CMML. We demonstrated the CMML clone was most likely derived from PV- JAK2V617F clone. This clone carried a complex genetic mutations of ASXL1, RUNX1, SRSF2 and TET2, NRAS, KRAS, plus CMML cells were of the classical phenotype CD14+ CD16−by flow cytometry. Keywords: Chronic myelomonocytic leukemia, Polycythemia vera, Monocytosis

Immunocompromised patients are predisposed to a variety of infections due to both common and uncommon pathogens. Achromobacter xylosoxidans, is an opportunistic pathogen most commonly encountered among immunocompromised patients. The authors report two cases of pulmonary infection due to A. xylosoxidans for the first time from this geographical area. First case is a 55-year-old diabetic female with pulmonary tuberculosis and second case is a 67-year-old male with Chronic Obstructive Pulmonary Disease (COPD). Alertness and rapid diagnosis led to favourable outcome in both these cases.

Metaplastic squamous cell carcinoma of the breast is a very rare form of breast cancer that consists of both glandular and nonglandular components mixed with epithelial and mesenchymal tissues. Worldwide, the incidence of this tumor is between 0.1 and 2%. Because of the rarity of this tumor and heterogeneous behavior of the tumor cells, it is difficult to establish the standard therapeutic approach. We report 2 cases of metaplastic squamous cell carcinoma of the breast in young patients with different responses to treatment strategies. The first case is a premenopausal female with metaplastic squamous cell carcinoma treated with surgery, chemotherapy, and radiotherapy, and the second case is perimenopausal metaplastic squamous cell carcinoma with sarcomatoid subtype and osteoid matrix production which progressed on chemotherapy and was treated with surgery and radiation.

Cold-adapted microorganisms represent a large fraction of biomass on Earth because of the dominance of low-temperature environments. Extreme cold environments are mainly dependent on microbial activities because this climate restricts higher plants and animals. Himalaya is one of the most important cold environments on Earth as it shares climatic similarities with the polar regions. It includes a wide range of ecosystems, from temperate to extreme cold, distributed along the higher altitudes. These regions are characterized as stressful environments because of the heavy exposure to harmful rays, scarcity of nutrition, and freezing conditions. The microorganisms that colonize these regions are recognized as cold-tolerant (psychrotolerants) or/and cold-loving (psychrophiles) microorganisms. These microorganisms possess several structural and functional adaptations in order to perform normal life processes under the stressful low-temperature environments. Their biological activities maintain the nutrient flux in the environment and contribute to the global biogeochemical cycles. Limited culture-dependent and culture-independent studies have revealed their diversity in community structure and functional potential. Apart from the ecological importance, these microorganisms have been recognized as source of cold-active enzymes and novel bioactive compounds of industrial and biotechnological importance. Being an important part of the cryosphere, Himalaya needs to be explored at different dimensions related to the life of the inhabiting extremophiles. The present review discusses the distinct facts associated with microbial ecology from the Himalayan cryosphere perspective.

Hepatitis B virus (HBV) infection is common across the world, especially in Asia, Africa, Southern Europe, and Latin America. The association of HBV infection in patients suffering from different oncological conditions is well established. Many cases of HBV reactivation have been reported in patients on immunosuppressive chemotherapy and in patients undergoing hematopoietic bone marrow transplantations. Only one case has been reported so far of HBV reactivation in a patient treated with programmed cell death receptor 1 (PD-1) checkpoint inhibitors in the setting of HIV status. We report a case of a 51-year-old male, former smoker, diagnosed with stage IV poorly differentiated adenocarcinoma of the lung, and started on pembrolizumab, who developed reactivation of chronic hepatitis requiring antiviral therapy.

Context: Carbapenemase production is an important mechanism responsible for carbapenem resistance. Aims: Phenotypic detection and differentiation of types of carbapenemase in carbapenem resistant Enterobacteriaceae is important for proper infection control and appropriate patient management. Settings and Design: We planned a study to determine the occurrence of Class A Klebsiella pneumoniae carbapenemase (KPC type) and Class B Metallo-β-lactamase (MBL type) carbapenemase in hospital and community. Materials and Methods: Clinical isolates of Escherichia coli and Klebsiella species and simultaneously evaluate different phenotypic methods for detection of carbapenemases. Results: It was observed that 20.72% clinical isolates of E. coli and Klebsiella spp. were resistant to carbapenem on screening of which, 14.64% were E. coli and 29.69% were Klebsiella spp. Using phenotypic confirmatory tests the occurrence of carbapenemase production was found to be 87.01% in E. coli and 91.51% in Klebsiella spp. using both modified Hodge test (MHT) and combined disk test (CDT) using imipenem-ethylenediaminetetraacetic acid. Conclusions: Both MBL and KPC type carbapenemases were seen among clinical isolates of E. coli and Klebsiella spp. CDT is simple, rapid and technically less demanding procedure, which can be used in all clinical laboratories. Supplementing MHT with CDT is reliable phenotypic tests to identify the class A and class B carbapenemase producers.

Sphingomonas paucimobilis , a yellow-pigmented, aerobic, glucose nonfermenting, Gram-negative bacilli is a rare cause of human infection. It was first discovered as an infective agent in humans in 1977 and named Pseudomonas paucimobilis. It was renamed as S. paucimobilis in 1990 in accordance with phylogenetic data. S. paucimobilis is an aerobic bacterium found in soil and water; it is a rare cause of healthcare associated infections. S. paucimobilis can cause infections in healthy as well as immunocompromised individuals. At first, its colony looks like Gram-positive bacilli colony, so by mistake it is discarded as contaminants. S. paucimobilis is an emerging pathogen and it should not be discarded as contaminants. Here, we report a case of S. paucimobilis bacteremia in a neonate who presented with respiratory distress.

Introduction: Enterococci are recognized as opportunistic pathogens, as well as commensals in both humans and animals. They are an important cause of nosocomial infections, difficult to treat, as the organism have intrinsic and acquired resistance to many antibiotics. Aim: To isolate and identify clinically relevant Enterococcus up to species level from all the clinical samples processed in the microbiology laboratory and also to study their resistance pattern. Materials and Methods: A prospective study was carried out for a period of one year from May 2014 to April 2015 at the Department of Microbiology, Subharti Medical College, Meerut, Uttar Pradesh, India. A total of 200 isolates of Enterococcus species from 15342 clinical samples obtained from IPD/OPD patients irrespective of age, having suspicion of bacterial infection were processed in the microbiology laboratory. Identification was done with standard biochemical methods. Antibiotic susceptibility testing was done on Muller Hilton agar plate by Kirby Bauer disc diffusion method. High-Level Gentamycin Resistance (HLGR) and High-Level Streptomycin Resistance (HLSR) were further confirmed by Agar dilution method and Broth microdilution method. Vancomycin and linezolid resistance was further confirmed by Agar dilution method and MIC was calculated by using VITEK 2, Biomerieux. All methodology was followed as per Clinical and Laboratory Standards Institute (CLSI) M100-S 24, 2014 guidelines. Results: E. faecalis (n=169, 84.5%) was the predominant species isolated, followed by E. faecium (n=27, 13.5%) and E. casseliflavus (n=4, 2%). A total of 25 (12.5%) isolates were HLGR, 13 (6.5%) isolates were HLSR and 62 (31%) isolates were HLGR+HLSR. Vancomycin resistance was found in 14 (7%) isolates of which 11 (78.5%) were Van A and 3 (21.4%) were Van B, detected phenotypically as per relative MIC of vancomycin and teicoplanin. Linezolid resistance was seen in 4 (2%) of isolates which were vancomycin as well as high-level gentamycin and high-level streptomycin resistant. Conclusion: Isolation of Enterococcus species resistant to most of the higher antibiotics like vancomycin and linezolid, with high prevalence of High-Level Aminoglycoside Resistance (HLAR), from hospitalized patients is a major concern as such isolates have limited or no therapeutic option.

Introduction: Chronic Suppurative Otitis Media (CSOM) still is a common health care problem in developing countries like India with its potential for serious local damage and complications. Knowledge of causative microorganisms and their antimicrobial sensitivity pattern is essential so that early and effective therapeutic measures can be initiated for better patient outcome. Aim: The study was carried out to determine the clinicomicrobiological spectrum of CSOM from this geographical area and to evaluate the susceptibility pattern of aerobic bacterial isolates. Materials and Methods: The prospective study was carried out for a period of one year from December 2013 to November 2014 in Chhatrapati Shivaji Subharti Hospital, a Tertiary Care Hospital in Meerut city. A total of 113 ear discharge was collected from clinically suspected cases of CSOM. The discharge was cultured on blood agar and Mac Conkey’s agar plates for isolation of bacterial pathogen and Sabourauds Dextrose Agar (SDA) slants for isolation of fungal pathogens. Identification of the bacterial and fungal isolates was done using standard bacteriological and mycological methods respectively. Antimicrobial susceptibility testing of the bacterial isolates was performed by Kirby-Bauer’s disc diffusion method as per the Clinical Laboratory Standards Institute (CLSI) guidelines. Further, detection of Metallo Beta Lactamase (MBL) production, Methicillin Resistance in Staphylococcus aureus (MRSA) and Extended Spectrum Beta –Lactamase (ESBL) production was carried out by phenotypic methods. Result: A total of 73.45% cases were culture positive. Pure bacterial pathogen was isolated from 67.46 % followed by pure fungal pathogen 22.89% and mixed pathogen (bacteria and fungus) from 9.63% of cases. Pseudomonas aeruginosa and Staphylococcus aureus were the predominant bacterial pathogen and Aspergillus spp. and Candida species were the predominant fungal pathogens isolated. Overall the rate of MBL producers, MRSA and ESBL producers were 18.18%, 52.94% and 62.5% respectively. Conclusion: High level of resistance was observed in cases of CSOM from our hospital. Therefore, knowledge of the causative microorganisms and its susceptibility pattern is required and this data may contribute to an effective management of cases of CSOM.

Background: AmpC beta lactamases are cephalosporinases that confer resistance to a wide range of beta lactam drugs thereby causing serious therapeautic problem. As there are no CLSI guidelines for detection of AmpC mediated resistance in Gram negative clinical isolates and it may pose a problem due to misleading results, especially so in phenotypic tests. Although cefoxitin resistance is used as a screening test, it does not reliably indicate AmpC production. Materials and Methods: We planned a study to determine the occurrence of AmpC beta lactamase in hospital and community, clinical isolates of Escherichia coli and simultaneously evaluate different phenotypic methods for detection of AmpC beta lactamases. Results: It was observed that 82.76% isolates were ESBL positive and 59% were cefoxitin screen positive. Using phenotypic confirmatory tests the occurrence of Amp C beta lactamases was found to be 40% and 39% by inhibitor based method using boronic acid (IBM) and modified three dimensional test (M3D) respectively. Conclusion: Both the test showed concordant result. Co-production was observed in 84.62% isolates Screening of ESBL and Amp C can be done in routine clinical microbiology laboratory using aztreonam and IBM respectively as it is a simple, rapid and technically less demanding procedure which can be used in all clinical laboratories.

Introduction: Bio-Medical Waste (BMW) management is of utmost importance as its improper management poses serious threat to health care workers, waste handlers, patients, care givers, community and finally the environment. Simultaneously, the health care providers should know the quantity of waste generated in their facility and try to reduce the waste generation in day-to-day work because lesser amount of BMW means a lesser burden on waste disposal work and cost saving. Aim: To have an overview of management of BMW in a tertiary care teaching hospital so that effective interventions and implementations can be carried out for better outcome. Materials and Methods: The observational study was carried out over a period of five months from January 2016 to May 2016 in Chhatrapati Shivaji Subharti Hospital, Meerut by the Infection Control Team (ICT). Assessment of knowledge was carried out by asking set of questions individually and practice regarding awareness of BMW Management among the Health Care Personnel (HCP) was carried out by direct observation in the workplace. Further, the total BMW generated from the present setup in kilogram per bed per day was calculated by dividing the mean waste generated per day by the number of occupied beds. Results: Segregation of BMW was being done at the site of generation in almost all the areas of the hospital in color coded polythene bags as per the hospital protocol. The different types of waste being collected were infectious solid waste in red bag, soiled infectious waste in yellow bag and sharp waste in puncture proof container and blue bag. Though awareness (knowledge) about segregation of BMW was seen in 90% of the HCP, 30%-35% did not practice. Out of the total waste generated (57912 kg.), 8686.8 kg. (15%) was infectious waste. Average infectious waste generated was 0.341 Kg per bed per day. The transport, treatment and disposal of each collected waste were outsourced and carried out by ‘Synergy’ waste management Pvt. Ltd. Conclusion: The practice of BMW Management was lacking in 30-35% HCP which may lead to mixing of the 15% infectious waste with the remaining non-infectious. Therefore, training courses and awareness programs about BMW management will be carried out every month targeting smaller groups.

Hyperimmunoglobulin E syndrome (HIES), also known as Job′s syndrome, is a rare primary immunodeficiency characterized by eczema, recurrent skin and lung infections, elevated serum IgE, and connective tissue and skeletal abnormalities. Individuals with HIES share a characteristic facial appearance and many oral manifestations including retained primary dentition, a high-arched palate, variations of the oral mucosa and gingiva, and recurrent oral candidiasis. An 18-year-old lady presented with gingival swelling, bleeding from the gums, recurrent skin infections, and recurrent respiratory infections with intermittent fever. After thorough extra oral, intra oral and radiographic examination, serological investigations were performed. Growth of candida hyphae in the biopsy specimen of gingiva and increased levels of serum IgE with typical extra oral findings established the diagnosis as Job′s syndrome (hyper IgE syndrome). Treatment with anti-fungal antibiotics and phase-I therapy including scaling and root planing followed by gingivoplasty using diode laser (980 nm) was performed. HIES was previously defined on the basis of clinical manifestations and laboratory markers that were not specific to the disease. With the identification of STAT3 mutations as the cause of HIES, we can definitively characterize the disease at molecular and immunologic levels. This case emphasizes the role of the dentist in the diagnosis of rare syndromes which alters the treatment plan.

Indole negative Proteus species are invariably incorrectly identified as Proteus mirabilis, often missing out isolates of Proteus penneri. We report a case of extended spectrum beta lactamase producing and multidrug-resistant P. penneri isolated from pus from pressure sore of a patient of road traffic accident. Correct and rapid isolation and identification of such resistant pathogen are important as they are significant nosocomial threat.

Background: Vancomycin may be ineffective against an increasing proportion of methicillin resistant Staphylococcus aureus (MRSA) with minimum inhibitory concentrations (MICs) well within the susceptible range. On the other hand it is common knowledge that determination of vancomycin MICs is method dependent. Therefore, given the apparent variability in vancomycin MIC results obtained with the different methods, the use of the vancomycin MIC to predict the outcome of serious S. aureus infections needs to take into account the method used and the results of studies using that particular method. Aim: Comparative study was carried out to evaluate the MICs obtained by BMD method, E-test, and Vitek 2 method and to detect inconsistencies in these vancomycin for 66 MRSA isolates obtained from various samples of patients attending the OPDs & IPDs within a period of one year. Materials and Methods: A comparative study was carried out to evaluate the MICs obtained by BMD method, E-test, and Vitek 2 method to detect vancomycin susceptibility in 66 clinical isolates of MRSA obtained from various samples of patients attending the OPDs & IPDs within a period of one year. The study was conducted in Department of Microbiology, Subharti Medical College, Meerut from January to December 2012. Results: On determination of MICs for vancomycin for the MRSA isolates, all were identified as VSSA by BMD, E-Test & Vitek 2 methods. However, the vancomycin MIC values obtained by E-test correlated better with BMD method (correlation factor= 0.6727) than Vitek 2 (correlation factor=0.5316), indicating E-Test to be a better method for determination of vancomycin MICs as compared to Vitek 2. Conclusion: MRSA isolates with higher vancomycin MICs, even within the susceptibility range, are being observed more frequently which result in treatment failures with vancomycin. Because of the discrepancy that exists in vancomycin MIC results from different methods, the prediction of outcome of serious S.aureus infections should take into account the method used & results of studies using that particular method.

A 40-year-old male patient presented to us with complaints of pain in abdomen for the past 2 weeks and fever for 3 days. The patient gave history of being previously operated for hydatid cyst of liver 15 years back. His chest radiograph and com-puted tomography scan revealed a cystic lesion in the right lobe of liver and a cyst in left lung. The patient was managed surgically. Aspirate from the cyst fluid showed plenty of hooklets and scolices of Echinococcus granulosus. An intact brood capsule was also seen. Diagnosis of hydatidosis was further confirmed by histo-pathological examination. Post-operative the patient had a good recovery.

Periodontal disease is a chronic infection of the gums characterised by a loss of attachment between the tooth and bone, and bone loss. C-reactive protein (CRP) elevation is a part of the acute phase response to acute and chronic inflammation. Many epidemiological studies have shown that serum CRP levels were elevated in patients with chronic periodontitis. CRP levels increase to hundreds of μg/ml within hours following infection. It out-performs erythrocyte sedimentation rate (ESR) in terms of responsiveness and specificity for inflammation. While CRP elevation is suggestive of inflammation or infection in the appropriate clinical context, it can also occur with obesity and renal dysfunction. Conversely, a lack of CRP elevation in inflammation may be seen with hepatic failure, as well as during flares of conditions such as systemic lupus erythematosus.

Shigella flexneri is the most commonly isolated species in the developing world. Prompt and appropriate therapy is necessary in shortening the duration of clinical symptoms, as well as to prevent transmission of infection to close contacts. Emerging multidrug resistant strain of Shigella is a growing concern across the globe and in India. Herein we report a case of dysentery in a child caused by an extended spectrum beta lactamase (ESBL) producing and multidrug resistant (MDR) S. flexeneri so as to alert the clinicians, microbiologists and epidemiologists regarding the emergence of resistance in Shigella spp. An outbreak of shigellosis by such resistant strains in overcrowded communities will be a tough challenge in the containment of the disease.

The molecule, 1,2-Bis(2-benzimidazolyl)-1,2-ethanediol (BBE) is known to act as a selective inhibitor of poliovirus, rhinovirus, Candida albicans, several bacterial species, and is easily synthesized by Phillips reaction. The interaction of BBE with BSA and the effects of its binding on the conformation and unfolding/refolding pathways of the protein were investigated using multispectroscopic techniques and molecular modeling. The binding studies indicate that BSA has one high affinity BBE binding site with association constant 6.02±0.05×10(4) M(-1) at 298 K. By measuring binding at different temperatures, we determined the changes in enthalpy (ΔH = -15.13±2.15 kJ mol(-1)), entropy (ΔS = 40.87±7.25 J mol(-1) K(-1)) and free energy (ΔG( = )26.78±1.02) of interaction, which indicate that the binding was spontaneous and both enthalpically and entropically driven. Based on molecular modeling and thermodynamic parameters, we proposed that the complex formation involved mainly hydrophilic interaction such as hydrogen bonding between hydroxyl groups of ethane-1,2-diol fragment with Tyr410 and benzimidazole sp(2) nitrogen atom with Ser488 and hydrophobic interaction between phenyl ring of one benzimidazole of the ligand and hydrophobic residues namely, Ile387, Cys391, Phe402, Val432 and Cys437. The sequential unfolding mechanism of BSA, site-specific marker displacement experiments and molecular modeling showed that the molecule preferably binds in subdomain IIIA. The BBE binding to BSA was found to cause both secondary and tertiary structural alterations in the protein as studied by intrinsic fluorescence, near-UV and far-UV circular dichroism results. The unfolding/refolding study showed that BBE stabilized native to intermediate states (N⇌I) transition of the protein by ∼2 kJ mol(-1) without affecting the intermediate to unfolded states (I⇌U) transition and general mechanism of unfolding of BSA.

The bark of Ficus religiosa L., Ficus benghalensis L., Ficus gloomerata L., fruits of Tribulus terrestris L. and roots of Saussurea lappa Clarke. were investigated for in vitro antibacterial activity. The various solvent extracts like petroleum ether, chloroform, aqueous and methanol of plants were screened against Neisseria gonorrhoeae isolated from the patients suffering from vaginitis. The extracts were subjected for antibacterial activity against the pathogen at 200mg/ml concentration by agar well diffusion and agar disc diffusion method. The results of antibacterial activity revealed that methanol extracts of all the plants exhibits good activity as compared to petroleum ether, chloroform and aqueous extracts. The antibacterial activities of extracts were compared with standard antibiotic cefotaxime. The MIC of the methanol extract of all the plants was also calculated against the pathogen.

The incidence of enteric fever caused by Salmonella enterica serotype Paratyphi A has been increasing in India since 1996. In 1998, the incidence of enteric fever caused by drug-resistant S. Paratyphi A abruptly increased in the New Delhi region. In the first 6 months of 1999, 32% of isolates were resistant to both chloramphenicol and cotrimoxazole and another 13% were resistant to more than two antibiotics.