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Artesunate is an effective and first-line therapy option in patients with severe malaria caused by Plasmodium species. Among adverse effects of the drug is a phenomenon of delayed hemolysis. This usually occurs at least 7 days after initiation of therapy, and is characterized by reductions in hemoglobin and haptoglobin and an increase in lactate dehydrogenase. Here, we report an instance of delayed hemolysis in a patient probably attributed to parenteral artesunate therapy.

Graphical abstract, Highlights • Taxonomic identification of a native silver-resistant bacterial strain. • Synthesis of silver nanoparticles (AgNPs) by the green method. • Characterization of purified AgNPs by spectroscopic and imaging techniques. • Measurement of antibacterial activity of AgNPs against human pathogens. • Estimation of anticancer potential of AgNPs against liver cancer cell line., Green nanomaterials have gained much attention due to their potential use as therapeutic agents. The present study investigated the production of silver nanoparticles (AgNPs) from a silver-resistant Bacillus safensis TEN12 strain, which was isolated from metal contaminated soil and taxonomically identified through 16S rRNA gene sequencing. The formation of AgNPs in bacterial culture was confirmed by using UV–vis spectroscopy with an absorption peak at 426.18 nm. Fourier transform infrared (FTIR) spectroscopy confirmed the involvement of capping proteins and alcohols for stabilization of AgNPs. Moreover, X-ray diffraction analysis (XRD), scanning and transmission electron microscopy (SEM and TEM) confirmed the crystalline nature and spherical shape of AgNPs with particle size ranging from 22.77 to 45.98 nm. The energy dispersive X-ray spectroscopy (EDX) revealed that 93.54% silver content is present in the nano-powder. AgNPs showed maximum antibacterial activity (20.35 mm and 19.69 mm inhibition zones) at 20 µg mL−1 concentration against Staphylococcus aureus and Escherichia coli, respectively and significantly reduced the pathogen density in broth culture. Furthermore, AgNPs demonstrated significant anticancer effects in the human liver cancer cell line (HepG2) in MTT assay, whereas, no cytotoxic effects were demonstrated by AgNPs on normal cell line (HEK293). The present study suggests that the biogenic AgNPs may substitute chemically synthesized drugs with wider applications as antibacterial and anticancer agents.

AIM: To introduce a simple iris hook assisted phacoemulsification (PE) procedure and evaluate the safety and efficacy of it in completely vitrectomized eyes. METHODS: A single centre study which included 65 previously completely vitrectomized eyes of 62 patients who underwent cataract surgery. Patients were randomly divided into 3 groups. Patients received PE, and intraocular lens (IOL) implantation with the assistance of iris hook (SynergetiesTM) as group A (25 eyes); patients who received PE assisted with a 25G pars plana irrigation as group B (20 eyes), and patients who received PE performed without the help of any instrument as group C (20 eyes). Main outcome measures were surgery duration, Ultrasound (U/S) total time, endothelial cell density (ECD), cumulative dissipated energy (CDE) and complications of the procedures. RESULTS: With the help of iris hook, the patients in group A had the lowest ECD loss rate (0.07±0.03, 0.09±0.03, and 0.10±0.03, P

Tsukamurella spp. are gram-positive rods that can be isolated from the environment in soil and moist areas. In rare instances, they are known to cause infections in immunocompromised hosts. We present the first reported case of Tsukamurella endocarditis in an immunocompromised patient who was successfully treated with a 6-week course of imipenem and trimethoprim-sulfamethoxazole.

Purpose: A case of a patient with sepsis from a urinary source due to carbapenemase-producing Klebsiella pneumoniae treated with a novel combination of aztreonam, ceftazidime/avibactam, and colistin is described. Summary: An 80-year-old South Asian male presented to the hospital with sepsis from a urinary source. Blood and urine cultures were positive for a carbapenemase-producing K pneumoniae sensitive only to colistin and tigecycline. Novel beta-lactamase inhibitor combinations ceftazidime/avibactam and meropenem/vaborbactam were resistant. Patient was initially on ceftazidime/avibactam and colistin combination followed by tigecycline and colistin with lack of improvement. Metallo-beta-lactamase (MBL)-producing K pneumoniae was suspected based on the sensitivity pattern and history of medical treatment in India. Patient was then initiated on novel combination of ceftazidime/avibactam, aztreonam, and colistin. Patient’s white blood cell (WBC) count and fever curve normalized. Unfortunately, the patient failed to recover completely likely because of his multiple comorbidities and declining functional status, resulting in the family’s decision to pursue hospice. Conclusion: The combination of ceftazidime/avibactam and aztreonam should be considered as a viable treatment option for patients with infections caused by MBL-producing Enterobacteriaceae.

Renal dysfunction is a significant risk factor for acyclovir-induced neurotoxicity and altered mentation and myoclonic movements are the most common clinical symptoms observed. In majority of reported cases, neurological sequelae associated with acyclovir-induced neurotoxicity often mimic viral infections of the central nervous system and makes diagnosis of the former challenging. Although plasma concentrations of the drug may not always correlate with neurotoxic symptoms, obtaining serum levels of acyclovir may be helpful in confirming drug-induced neurotoxicity. Hemodialysis has been shown to significantly improve altered mentation in patients with suspected or confirmed acyclovir-induced neurotoxicity. Here, we report a definite case of acyclovir-induced neurotoxicity in a patient with end-stage renal disease. Clinical improvements in neurologic symptoms were observed following discontinuation of the drug and hemodialysis.

We present an unusual case and management plan for a complicated case of Burkholderia Pseudomallei. A 75 year old male travelled to the United States from Southeast Asia, and presented acutely to the emergency room with fevers and difficulty breathing. He was diagnosed with a pulmonary embolus, following radiological imaging. Concurrently, with his acute presentation, he was found to have an underlying infection, diagnosed to be from Burkholderia Pseudomallei. He was treated initially with intravenous antibiotics and sent home with a prolonged regimen of oral antibiotics. Despite being on antibiotics, and being completely asymptomatic, he seeded the infection to his vascular graft. This was placed via endovascular technique to treat a ruptured right ileac artery aneurysm. The graft was placed well after the infection was diagnosed and treated. This bacteria is endemic to Southeast Asia, however, with global travel, the prevalence is increasing in multiple different countries and continents. A brief detailed review of Burkholderia Pseudomallei was undertaken and presented, along with a management plan for addressing the abdominal vascular infection. It is important for the clinician to maintain an index of suspicion in the setting of patient presentation, occupation, recent travel and both radiological and pathological findings.

The emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) linked with coronavirus disease 2019 (COVID-19) poses a serious threat to public health worldwide. Firstly, the SARS-CoV-2 was reported in Wuhan, Hubei Province, China in December 2019. Initially, the major proportion of virus-infected cases (i.e. about 99%) was reported in China and now it is being reported in other counties as well. Humans begin to be infected within their communities and transmittance of the viral epidemic increased rapidly due to lack of understanding of its transmission routes and precautionary measures. The existence of SARS-CoV-2 in China threatened the population greatly due to the high incidence of fatal respiratory infections. Current investigations speculated that this virus transferred into a human from viral-infected bats. However, the process of interspecies viral transmission is an important scientific question to be addressed. Due to the continuous increase in the patients infected with COVID-19 associated pneumonia, the World Health Organization (WHO) has included this viral epidemic to the priority list of diseases. Therefore, accelerated research developments are required to control the spread of this outbreak, as it is declared as a public health emergency by WHO especially in the absence of efficacious drugs and vaccines. Our review encompasses the recent status of disease severity in China, a particular replication mechanism of SARS-CoV-2 and potential risks and precautionary measures required to avoid contact with this fatal viral infection.

The emergence of novel coronavirus strain 2019 (COVID-19) linked with pneumonia poses a serious threat to public health worldwide. Firstly, the COVID-19 was reported in Wuhan, Hubei Province, China in December 2019. Initially, the major proportion of virus-infected cases (i.e. about 99%) was reported in China and now it is being reported in other counties as well. Humans begin to be infected within their communities and transmittance of the viral epidemic increased rapidly due to lack of understanding of its transmission routes and precautionary measures. The existence of COVID-19 in China threatened the population greatly due to the high incidence of fatal respiratory infections. Current investigations speculated that this virus transferred into a human from viral-infected bats. However, the process of interspecies viral transmission is an important scientific question to be addressed. Due to the continuous increase in the patients infected with COVID-19, the World Health Organization (WHO) has included this viral epidemic to the priority list of diseases. Therefore, accelerated research developments are required to control the spread of this outbreak, as it is declared as a public health emergency by WHO especially in the absence of efficacious drugs and vaccines. Our review encompasses the recent status of disease severity in China, a particular replication mechanism of COVID-19 and potential risks and precautionary measures required to avoid contact with this fatal viral infection.

The current coronavirus (COVID-19) pandemic has a high spreading and fatality rate. To control the rapid spreading of the COVID-19 virus, the government of India imposed lockdown policies, which creates a unique opportunity to analyze the impact of lockdown on air quality in the two most populous cities of India, i.e., Delhi and Mumbai. To do this, the study employed a spatial approach to examine the concentration of seven criteria pollutants, i.e., PM

The current coronavirus (COVID-19) pandemic has a high spreading and fatality rate. To control the rapid spreading of the COVID-19 virus, the government of India imposed lockdown policies, which creates a unique opportunity to analyze the impact of lockdown on air quality in the two most populous cities of India, i.e., Delhi and Mumbai. To do this, the study employed a spatial approach to examine the concentration of seven criteria pollutants, i.e., PM2.5, PM10, NH3, CO, NO2, O3, and SO2, before, during, and after a lockdown in Delhi and Mumbai. Overall, around 42%, 50%, 21%, 37%, 53%, and 41% declines in PM2.5, PM10, NH3, CO, NO2, and SO2 were observed during the lockdown period as compared to previous years. On the other hand, a 2% increase in O3 concentration was observed. However, the study analyzed the National Air Quality Index (NAQI) for Delhi and Mumbai and found that lockdown does not improve the air quality in the long term period. Our key findings provide essential information to the cities' administration to develop rules and regulations to enhance air quality.

Periprosthetic joint infections (PJIs) are expected to become more common in the future as total joint arthroplasties increase in frequency. PJIs are difficult to differentiate from mechanical failure. The diagnosis and treatment of PJIs is often dependent on the results of cultures obtained from the joint or periprosthetic space. Criteria for diagnosis of periprosthetic joint infection vary, but usually include one or more of the following: presence of a sinus tract, recovery of a typical organism from multiple joint fluid or tissue cultures, elevated joint fluid white cell count with neutrophil predominance, presence of pus at the time of surgery, histopathology consistent with acute inflammation and high erythrocyte sedimentation rate and C reactive protein. Staphylococcus aureus and coagulase-negative staphylococci are the most common organisms associated with PJIs. Streptococci, gram-negative bacteria and anaerobes are seen less frequently. Mycobacterium tuberculosis, fungi, and other unusual organisms are rare but may be seen in cases where the routine bacterial cultures are negative.