IS BACTERIOLOGY A CONTRIBUTING FACTOR IN UNSALVAGEABLE NATURE OF DIABETIC FOOT INFECTIONS?–A STUDY IN A DISTRICT HOSPITAL IN MALAYSIA

Objective: The objective is to study bacterial pathogens isolated in diabetic foot infection (DFI) and their sensitivity pattern to antibiotics commonly used in the management of DFI in the salvageable and unsalvageable groups of patients in a district hospital.Methods: 122 patients with diabetic limb infections treated at the Orthopedic Department of Hospital Sultan Abdul Halim, Sungai Petani, Kedah State in Malaysia. Clinically, limb infections were classified as salvageable and unsalvageable infections. Salvageable-mild, superficial/deep, localized ulcer with no systemic derangements necessitating conservative treatment or surgical procedures with minor amputations of limb (toe/ray amputation). Unsalvageable-deep seated extensive or spreading ulcers threatening the integrity of limb with or without toxic symptoms or metabolic derangement and could result in major limb amputation. A standard questionnaire was used to collect demographic, clinical and microbiological details of patients in both groups. Co-morbid illnesses, type/severity of limb infection during presentation and results of routine blood investigations were recorded. Details of nature of each specimen, species of isolate pathogen and sensitivity pattern to antibiotic of each clinical isolates were recorded.Results: 62 and 60 patients respectively belonged to the salvageable and unsalvageable groups. Only 11.66% presented with evidence of toxemia in the unsalvageable group. ESBL was the commonest nosocomial organisms. Percentage of organism sensitivity was most to vancomycin, ceftazidime, and gentamicin.Conclusion: All severe infections do not present with toxemia in diabetic patients. Gram-negative organisms were predominant in both groups although Staphylococcal organisms were the single largest group in the unsalvageable group. 3rd generation antibiotics are more useful in its control.Â

A New Postulate on Two Stages of Dandruff: A Clinical Perspective

Dandruff (pityriasis capitis, seborrheic dermatitis confined to the scalp) is a disease that has been around for centuries despite several treatment options. Almost every day new players are entering the market with various antidandruff products, perhaps due to an increase in the incidence of dandruff all over the world. Interestingly, clinicians, especially dermatologists, gave little attention to this problem. At the end, the dandruff sufferer is puzzled by the array of antidandruff products with varied claims entering the market day by day. Why have we not achieved complete treatment success against dandruff? Is dandruff a disease or disorder? It seems that our understanding about dandruff perfectly fits into the famous saying of Albert Einstein, “as the area of light increases, so does the circumferences of darkness.” Have dermatologists left dandruff unattended, only to be exploited by the personal care industry

Different culture media containing methyldopa for melanin production by Cryptococcus species

INTRODUCTION: Melanin production by species of Cryptococcus is widely used to characterize C. neoformans complex in mycology laboratories. This study aims to test the efficacy of methyldopa from pharmaceutical tablet as a substrate for melanin production, to compare the production of melanin using different agar base added with methyldopa, and to compare the melanin produced in those media with that produced in Niger seed agar and sunflower seed agar by C. neoformans, C. laurentii, and C. albidus. Two isolates of each species, C. neoformans, C. laurentii, and C. albidus, and one of Candida albicans were used to experimentally detect conditions for melanin production. METHODS: The following media were tested: Mueller-Hinton agar (MHA), brain and heart infusion agar (BHIA), blood agar base (BAB), and minimal medium agar (MMA), all added with methyldopa, and the media Niger seed agar (NSA) and sunflower seed agar (SSA). RESULTS: All isolates grew in most of the culture media after 24h. Strains planted on media BAB and BHIA showed growth only after 48h. All isolates produced melanin in MMA, MHA, SSA, and NSA media. CONCLUSIONS: Methyldopa in the form pharmaceutical tablet can be used as a substrate for melanin production by Cryptococcus species; minimal medium plus methyldopa was more efficient than the BAB, MHA, and BHIA in the melanin production; and NSA and SSA, followed by MMA added with methyldopa, were more efficient than other media studied for melanin production by all strains studied

Rapid Identification of Cryptococcus neoformans and Cryptococcus gattii by Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry ▿

Compared to DNA sequence analysis, matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) correctly identified 100% of Cryptococcus species, distinguishing the notable pathogens Cryptococcus neoformans and C. gattii. Identification was greatly enhanced by supplementing a commercial spectral library with additional entries to account for subspecies variability