Occurrence and detection of AmpC β lactamases among clinical isolates of Enterobacteriaceae at a tertiary care hospital

INTRODUCTION: Discovery of antibiotics to treat infection caused by bacteria is the most important developement of modern medicine. But, resistance producing gram negative organisms like Ecoli,Klebsiella, citrobacter are plasmid mediated inducible AmpC producers. AmpC class ß – lactamases are cephalosporinases that are poorly inhibited by clavulanic acid. MATERIALS AND METHODS: This study was conducted after obtaining IHEC approval at the Diagnostic microbiology department , PSG Hospitals during the period Jan 2016 – July 2017 . Out of the 71067 various specimens received for culture and sensitivity at the microbiology department during the study period, 16552 microorganisms were isolated, of which 7123 ( 43.3%) were enterobacteriaceae identified after processing by standard microbiological techniques, colony morphology Gram’s staining, motility and biochemical reactions RESULT AND ANALYSIS: Out of the 256 cefoxitin resistant Enterobacteriaceae isolates, 182 (71.09%) of the isolates were found to be AmpC producers by the gold standard Modified 3 D (M3D) assay. Boronic acid inhibition test detected 176 (68.75%) isolates as AmpC producers followed by Ceftazidime – Imipenem Antagonism test , Disc Antagonism Test , Double disc synergy test & Cloxacillin Combined Disc Diffusion test CONCLUSION: Clinical laboratories needs to be upgraded with appropriate tools and qualified staff to recognize newer drug resistances emerging among Enterobacteriaceae. The most prevalent AmpC genes belonged to FOX, MOX and CIT in our study. The dissemination of these plasmid-mediated resistance genes within the hospital is an important public health issue. Identifying the types of AmpC may aid in hospital infection control

Removal of Acid Green 25 from Aqueous Solution by Adsorption

The adsorptive removal of Acid Green 25 by Ananas Comosus (L) Activated carbon was investigated in this study. The effects of initial dye concentration, contact time, pH and temperature were studied for the adsorption of Acid Green 25 in batch mode. At 100 mg/L of initial dye concentration the adsorbent removes 182.6 mg/g of dye from solution; it further increases on increasing the temperature. The calculated values of ∆G° indicate that the adsorption process is spontaneous, negative ∆H° indicate that the adsorption process is exothermic and the positive value of ∆S° indicates the increase in randomness. The rate of dye adsorption follows pseudo second order model with an r2 value of 0. 999. Standard adsorption isotherms were used to fit the experimental equilibrium data. The Langmuir, Freundlich, and Tempkin models are appropriate to explain the adsorption phenomenon with good fit

Rhino cerebral mucormycosis in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a multisystem connective tissue disease. Patients with SLE develop cutaneous infections due to immune dysregulation and treatment with immunosuppressive agents. Deep fungal infections are rare in SLE but are important cause of morbidity. We report a case of successfully treated rhino cerebral mucormycosis (RCM) in a female patient with SLE

Mercury toxicity following unauthorized siddha medicine intake – A mimicker of acquired neuromyotonia - Report of 32 cases

Context: Mercury is used extensively in the preparation of Siddha medicines, after purification. In this study, we present 32 patients of mercury toxicity following unauthorized Siddha medicine intake who mimicked neuromyotonia clinically. We analyzed the clinical features of these patients, the role of autoimmunity in etiopathology, and compared it with acquired neuromyotonia. Subjects and Methods: This is a retrospective study to analyze inpatients in a tertiary care center, admitted with mercury toxicity following Siddha medicine intake from August 2012 to October 2016. We analyzed the clinical features, laboratory data including mercury, arsenic and lead levels in blood, and serum voltage-gated potassium channels (VGKC)-CASPR2 Ab in selected patients. Results: Thirty-two patients who had high blood mercury levels following Siddha medicine intake were included in the study. All patients (100%) had severe intractable neuropathic pain predominantly involving lower limbs. Twenty-six (81.25%) patients had fasciculations and myokymia. Fifteen patients (46.86%) had autonomic dysfunction (postural hypotension and resting tachycardia). Nine (28.12%) patients had encephalopathic features such as dullness, apathy, drowsiness, or delirium. Anti-VGKC Ab was positive in 12 patients with myokymia. All the patients in the study consumed Siddha medicines obtained from unauthorized dealers. Conclusions: Mercury toxicity following Siddha medicine intake closely mimics acquired neuromyotonia; severe intolerable neuropathic pain is the hallmark feature; Positive VGKC-CASPR2 antibody in some patients must be due to triggered autoimmunity secondary to mercury toxicity due to Siddha medicine intake. The government should establish licensing system to prevent distribution of unauthorized Siddha medicines