Cefepime/tazobactam as a new treatment option for multidrug resistant gram negative bacilli

Background: Every time an antibiotic is used, whether appropriately or not, the probability of the development and spread of antibiotic resistant bacteria is increased. Thus, multidrug resistant bacteria particularly ESBL (Extended spectrum β­lactamase), Amp C and carbapenemases producing gram negative bacilli have emerged as a major health problem all over the world. Considering new treatment options as a carbapenems sparing and resistance prevention modality, this study was aimed to know the in vitro susceptibility pattern of Cefepime/Tazobactam (CPM/TZ) in comparison to other β-Lactam/ β-Lactamase inhibitors (BL/BLI) and carbapenems against GNB.Methods: A prospective study was conducted on all clinical samples received for a period of about 1 year. Identification and susceptibility of all isolates was done by Vitek 2 Compact system. Susceptibility of CPM/ TZ was done by disc diffusion method on the basis of CLSI guidelines. Both fermenters (E. coli and Klebsiella pneumoniae) and non-fermenters (Acintobacter baumanii and Pseudomonas aeruginosa) were included in the study.Results: Out of 550 GNB isolates the most common was E. coli (61.8%), Acintobacter baumanii (16%), Klebsiella pneumoniae (14.9%) and Pseudomonas aeruginosa (7.3%). Cefepime/tazobactam had a much higher susceptibility of 68% compared to cefepime (28%). Among the BL/BLI combinations tested cefepime/tazobactam (68%) showed the maximum percentage of susceptibility followed by cefoperazone/sulbactam (61.5%) and piperacillin/tazobactam (57.6%). Amongst all GNB isolates cefepime/tazobactam (68%) sensitivity was very much comparable to imipenem (71.8%) and meropenem (69.6%).Conclusions: CPM/TZ exhibited the best in vitro activity in comparison to the other BL/BLI. This new combination of cefepime/tazobactam appears to be a promising alternative therapeutic option to carbapenems. Clinical studies are needed to confirm this in vitro study result

Creating order out of chaos : role of antenatal ultrasound in diagnosis

Background: Congenital high airway obstruction syndrome (CHAOS) is a rare fetal anomaly characterized by obstruction of the higher fetal airway. This could be either complete or incomplete and is more commonly seen at the subglottic level, resulting in a spectrum of characteristic secondary features. Case Report: In this case study, we report two cases of CHAOS with one showing laryngeal atresia and the other, tracheal atresia. Both these cases showed characteristic findings on a detailed, meticulous USG examination which led to this diagnosis. Conclusions: Early and accurate diagnosis offers a window of opportunity for parental counseling and management using procedures such as EXIT (ex-utero intrapartum procedure). Earlier, CHAOS was thought to be incompatible with life; however, with the advent of ex-utero intrapartum procedure, a few cases of post-natal survival have been noted in the literature. In this article, we emphasize the sonographic findings found in CHAOS. Early diagnosis offers an opportunity for a intrauterine fetal intervention in potentially lethal cases

To study the relation between spontaneous bacterial peritonitis and serum ascitis albumin gradient in chronic liver disease patients

Background: About half the patients with cirrhosis develop ascites during 10 years of observation. The present study was designed to study the relation between spontaneous bacterial peritonitis and serum ascites albumin gradient in chronic liver disease patients.Methods: This prospective observational study was done in 55 patients with chronic liver disease attending IPD of tertiary hospital. Based on investigation findings, patients were divided into two groups: Group A-Patients with sterile cirrhotic ascites, Group B- Patients with spontaneous bacterial peritonitis. Detailed history, examination and relevant investigation were done. Data was collected, recorded and statistical calculation was done using in Microsoft excel 2007.Results: Most common presenting symptoms of SBP patients were increasing ascites refractory to treatment (90%), followed by peripheral edema (80%). Jaundice and hepatic encephalopathy was found in 75% and 65% respectively. Serum and ascites albumin levels were lower in Group B (2.54±0.33 and 0.43±0.23 g/dl respectively) as compared to Group A (2.85±0.36 and 0.91±0.31 g/dl respectively) and it was statistically significant. The Mean±SD of SAAG for group A and group B was (1.94±0.36) and (2.09±0.47 g/dl) respectively. This difference was statistically not significant.Conclusions:Study conclude that the development of spontaneous bacterial peritonitis in chronic liver disease patients with sterile ascites is directly proportional to ascitic fluid albumin and serum albumin concentration whereas occurrence of SBP is not affected by variation in SAAG ratio if it is already higher than 1.1 g/dl.

EXPLORING PROPERTIES OF SWEET BASIL SEED MUCILAGE IN DEVELOPMENT OF PHARMACEUTICAL SUSPENSIONS AND SURFACTANT-FREE STABLE EMULSIONS

Objective: The objective of the investigation was to isolate mucilage from sweet basil seeds and explore its physicochemical properties for the development of pharmaceutical suspensions and surfactant-free stable emulsions.Methods: Possible applications of sweet basil seed mucilage in the pharmaceutical field for dosage form development are being explored. The physicochemical and functional properties of the mucilage from the seeds of the Ocimum basilicum L. (Sweet basil) have been investigated for stabilization of suspensions and emulsions. The following analyses were performed: FTIR spectroscopy, phytochemical tests, XRD, swelling and rheological studies.Results: The analyses showed that the mucilage is rich in glucose, mannose, and xylose. High swelling index values varying from 100±10 to 200±13%, high water-holding capacity of 97.5±2.4 g/g mucilage and reasonable oil holding capacity of the mucilage (13.2±1.3 g/g mucilage) makes it an ideal candidate for utilization as viscosifier and stabilizer of suspensions and surfactant-free emulsions. Adult and paediatric paracetamol suspension formulations with 1%w/v mucilage have exhibited flocculated nature and good stability owing to its high sedimentation volume(F= 0.85-0.98) and good redispersibility. Sunflower oil emulsions prepared with 0.25%w/v mucilage demonstrated emulsion stability index of 105.714 on 5th day and extremely low creaming rate of 0.0004 cm/h thus confirming maximum stability compared to emulsions developed with 0.3-0.5% w/v mucilage.Conclusion: The mucilage isolated from Ocimum basilicum L. seeds may be regarded as a functional biomaterial for pharmaceutical use to ensure quality and stability of liquid dosage forms

Streptococcus pneumoniae endopeptidase O (PepO): a multifunctional plasminogen and fibronectin binding protein, facilitating evasion of innate immunity and invasion of host cells.

Streptococcus pneumoniae infections remain a major cause of morbidity and mortality worldwide. Therefore a detailed understanding and characterization of the mechanism of host cell colonization and dissemination is critical in order to gain control over this versatile pathogen. Here we identified a novel 72 kDa pneumococcal protein endopeptidase O (PepO), as a plasminogen and fibronectin binding protein. Using a collection of clinical isolates, representing different serotypes, we found PepO to be ubiquitously present both at the gene and at the protein level. In addition, PepO protein was secreted in a growth-phase dependent manner to the culture supernatants of the pneumococcal isolates. Recombinant PepO bound human plasminogen and fibronectin in a dose-dependent manner and plasminogen did not compete with fibronectin for binding PepO. PepO bound plasminogen via lysine residues and the interaction was influenced by ionic strength. Moreover, upon activation of PepO bound plasminogen by urokinase-type plasminogen activator, generated plasmin cleaved complement protein C3b thus assisting in complement control. Furthermore, direct binding assays demonstrated the interaction of PepO with epithelial and endothelial cells that in turn blocked pneumococcal adherence. Moreover, a pepO-mutant strain showed impaired adherence to and invasion of host cells compared to their isogenic wild-type strains. Taken together, the results demonstrated that PepO is ubiquitously expressed plasminogen and fibronectin binding protein, which plays role in pneumococcal invasion of host cells and aids in immune evasion

Clinical approach to Megaliths of Salivary glands – Our Experience

Sialolithiasis is commonly found in middle age patients though to some extent have been reported in children also. It is the most common disease of salivary gland, the symptoms of which develop as a consequence of obstruction of the duct secreting the saliva. It involves the submandibular gland predominantly though other major gland involvement has been reported. Management of the sialolithiasis usually entails exfoliation via milking, invasion of the duct of the associated gland or complete excision of the involved gland

Method development and validation for acrylamide in potato cutlet by UHPLC-MS/MS

Surge in consumption of healthy and safe foods has challenged researchers to develop sensitive, precise, robust detection and quantification of food contaminants like acrylamide even if they are present in trace. Keeping this in view, a robust and sensitive analytical method was developed and validated for acrylamide quantification in a potato-based food product (potato cutlet), using LC-MSMS with positive electrospray ionization (+ESI). The method consists of adding acrylamide-d3 (deuterium labelled acrylamide) as an internal standard, extraction by modified QuEChERS method with d-SPE clean-up. Extracts were run on a reverse phase C-18 column for analysis by liquid chromatography. The limit of detection (LOD) and limit of quantification (LOQ) were determined as 0.7 and 2.0 μg kg− 1 , respectively, demonstrating the sensitivity of the method for trace detection. The developed method showed excellent results in terms of recoveries (91.0–109.16%), repeatability (RSD 1.8–10.60%), reproducibility (RSD 2.3–11.24%) and robustness (RSD 1.74–4.54%). The repeatability, reproducibility and robustness respectively, show the consistency, accuracy and stability of the developed method. The deviations in ion ratio and retention time were 17.25% and − 0.01 min, respectively. Compared to previous findings, the current study has achieved lower LOD and LOQ levels that reveals the higher sensitivity of this method for acrylamide quantification in potato cutletMinistry of Food Processing Industries, Government of India | Ref. Q-29/11/2018-R&DUniversidade de Vigo/CISU

A review of multi-criteria decision making techniques for supplier evaluation and selection

Supplier evaluation and selection has been a vital issue of strategic importance for long time. Different multi-criteria decision making (MCDM) approaches have been proposed by the researchers in past, to solve the supplier evaluation and selection problem. In this paper, we present a review of various MCDM methodologies reported in the literature for solving the supplier evaluation and selection process. The review is solely based on sixty-eight research articles, including eight review articles in the academic literature from 2000 to 2011. We try to find out the most prevalent approach in the articles and thereby present the future scope of arriving at an optimal solution to the problem, based on the specifications, the strategies and the requirements of the buyers. The study presents that with the change in processes and the requirements, how the approach of the manufacturing industry has shifted from striving for operational effectiveness to the strategic partnership in the dyadic relationship