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Background and Objectives: There are conflicting views regarding face mask guidelines amongst healthcare staff to prevent transmission of coronavirus disease 2019 (COVID-19), influenza and other respiratory viral infections (RVIs). We conducted a thorough meta-analysis to statistically compare mask use versus no mask use efficacy for RVIs in healthcare settings. Materials and Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used for selecting researches published between 2003 and June 2022 from different databases, including Publisher Med- line (PubMed), Web of Science, etc.; 6 studies qualified for inclusion. Data was pooled from in vivo randomized control, case-control and observational studies dealing with the relationship between face mask use and no use by patients or health personnel and RVI prevention in healthcare setups. Results: The fixed and random-effects model was carried out to determine pooled odds ratios (ORs) and their respective 95 percent confidence intervals (CIs). The results revealed that wearing a face mask significantly reduced the risk of contracting a respiratory viral illness in hospital settings, with pooled OR (95% CI) of 0.11 (0.04 to 0.33) (probability value (P)

Background: Coronavirus disease 2019 (COVID-19) associated inflammatory cytokine storm that worsens COVID-19, relies heavily on the inflammatory response. IL-6, a TH1 cytokine, PCT and CRP have been linked to serious illness and a higher mortality rate. We further tried to evaluate the role of these indicators and their association with clinical severity in COVID-19 patients. Material and Methods: Eighty-three consecutive patients with age ≥18 years with RT-PCR test positive for SARS-CoV-2 were included in the study. Demographic characteristics (age and sex), underlying co-morbidities, symptoms, physical findings, and laboratory tests of the patients were recorded. All patients were categorized as having mild, moderate, and severe COVID-19 disease, according to the Indian Council of Medical Research (ICMR). The levels of IL-6 and PCT were estimated by electrochemiluminescence immunoassay (ECLIA) using Cobas-e411 Immunoassay System, and Quantitative CRP was done by Unicorn-230 automated biochemistry analyzer to find out their correlation with disease severity and outcome. Multiple Regression was performed to find out factors associated with the adverse outcome of the disease. Result: Mean age of patients was 51 years. IL-6, CRP, and PCT levels increased in 73 %, 68.0 %, and 8.2 % patients on admission, respectively. The most common co-morbidity associated with the disease was hypertension (25%), followed by diabetes (24%) and respiratory disease (15%). Increased IL-6, CRP, and PCT levels were found in 77 percent, 79 percent, and 20 percent of patients, respectively. We found that IL-6 (P≤0.05), CRP (P≤0.05), and PCT (P≤0.05) were significantly raised in COVID-19 patients with increasing severity of the disease. The Area under the receiver operating characteristic (AUROC) of these parameters ranged between 0.65 and 0.8 (IL-6, 0.828; CRP, 0.809; and PCT, 0.658), indicating a reliable biomarker to assess clinical severity. Conclusion: Sequential measurement of blood levels of IL-6, CRP, and PCT levels is useful in determining the severity and predicting the outcome of the patients with severe disease. IL-6 and CRP have an independent prognostic value. On the other hand, the importance of normal PCT concentrations in patients with viral pneumonia needs to be studied further.

Introduction: Hand Hygiene is the cheapest, easiest and the single most effective measure to reduce cross-transmission of infection from one patient to another and from the healthcare workers to patients and vice versa. Multiple studies have shown a decrease in healthcare-associated infections (HCAIs) rates after improvement in hand-hygiene compliance. Despite being the simplest procedure adherence to the hand hygiene recommendations remains well below 50% and healthcare workers repeatedly observed as being poor compliers. Objective: This study was planned to access the impact of covid-19 pandemic on the compliance of infection control practices at a tertiary health care centre in India. Methods: Institution-based cross-sectional study was used to assess the impact of covid-19 pandemic on attitude, knowledge and on the compliance of hand hygiene practices at a tertiary health care centre in India. Results: A marked difference was observed in the availability of resources for hand hygiene i.e., 48 (96%) locations and the display of instructions for hand hygiene 50 (100%). A significant difference was also observed among the knowledge of the steps of hand hygiene {2019: 16(32%; 2020: 33 (66%)} and of the moments of hand hygiene {2019: 27 (54%); 2020; 44 (88%)}. (ϰ2 = 79.2, df =1, p = 0). In 2020 (during COVID -19 pandemic) a significant increase in compliance was noted in most of the departments with highest compliance rate of ICUs (100%), followed by OTs (91.7%), paediatrics (95.8%) obstetrics and gynaecology (90.6%), surgery (86.5%), blood bank and laboratories (85.7%). However, unlike the other parameters, the compliance of hand hygiene during the previous year (2019) and during 2020 (COVID -19 pandemic, was poor with no significant difference in compliance of hand hygiene practices even during the pandemic. Of all the 5 moments suggested by WHO, maximum compliance (36% in 2019 and 60% in 2020 pandemic) was after body fluid exposure. Conclusions: Hand Hygiene should be made a national priority. Active involvement by healthcare administrators, national and local governments should be committed to make hand hygiene a mandate for patient safety. Accessibility to hand hygiene products like soap and water and/or alcohol-based hand rubs and written and verbal reminders to staff are essential to improve the compliance of hand hygiene. Thrust should also be given to hand hygiene as a research subject.

Declared as a pandemic on March 11, 2020, COVID -19 has made it essential for the entire world to control and ensure safety measures for such infections in the future. To take any measures, one must be sure of the route of transmission of the agent causing Pandemic. With so many controversies in its mode of spread, COVID-19 has raised questions for the researchers to confirm its various modes of spread. Many of these modes can be overlooked; it is necessary to emphasize and illustrate them. The aim of this paper is to provide a brief overview of the various modes of COVID-19 transmission. According to the published literature, COVID-19 is primarily transmitted from person to person through oral and respiratory aerosols, with droplets from the virus-infected environment playing a minor role in disease transmission. The infection is particularly dangerous for healthcare workers and the elderly with comorbidities.

Background: This ongoing coronavirus disease 2019 (COVID-19) pandemic is a great challenge for our health-care systems and their infrastructure. Diagnostic confirmation of infected individuals based on RT-PCR is important for the containment of viral spread because, despite high viral loads, the infection can be asymptomatic. For overcoming the issue of limited supplies in low socio-economic countries like ours, pooling of specimens was proposed as a method to screen a large number of patients. To analyse the effect of pooling of samples on the sensitivity of RT-PCR, we compared Cycle threshold (Ct) values of pools with those of the deconvoluted (individual) samples. Materials and Methods: From March 2020 to October 2020, we performed COVID-19 testing by RT-PCR on samples from areas with varying prevalence of COVID-19 referred to VRDL, JNMCH, Aligarh. For circumventing the limited availability of RNA extraction and PCR reagents, pool testing was started. 5 samples were pooled together, and these pools were tested by RT-PCR. Negative pools were reported as negative, whereas positive pools were deconvoluted, and each sample was tested individually. In this study, 408 pools comprising of 2040 samples were analysed. Observations and Results: In our study, a ΔCt value of 0.96 (i.e., an increase in Ct value in the pooled sample as compared to individual sample) was found that shows a slight loss of PCR sensitivity in pooled samples, which is relatively small compared to the inherent clinical sensitivity of the standard assay. But the cost-effectiveness and the ability to reserve resources are considerably high. Conclusion: As pooling of samples is a cost-effective way for COVID--19 testing, the slight loss in the sensitivity of RT-PCR can be overcome by considering the Ct cut-off value for positive pools slightly above the kit cut off value to circumvent the dilution effect.

Purpose: COVID-19, a pandemic declared on March 11th, 2020, makes it crucial for the whole world to control and ensure safety measures to control such infections in the future. Fear, worry, and panic remain widespread, especially among healthcare workers. We aimed to compare the knowledge, attitude, anxiety, and behaviours of medical and non-medical students towards vaccination against COVID-19. Material and Methods: We conducted a cross-sectional study for one month on the MBBS/BDS and undergraduate nonmedical students through an online questionnaire which consisted of a multiple choice KAP questionnaire consisting of four sections (i.e., socio-demographic details, knowledge, attitudes, and behavior). Multiple linear regression was performed to determine the variables predicting knowledge and attitudes towards COVID-19 vaccination. Results: Vaccine hesitancy was detected in 17% of Undergraduate Medical Students, while the same was noted in 45% of non-medical students. 48.7% of medical students knew about different vaccines available in India for COVID-19 viz a viz the same in non-medical students was 49.5%. The majority of the students (35.8% medical and 48.6% non-medical) considered Covishield the best currently available vaccine in India. The majority of the students (Medical 86.5% and non-medical 75.2%) thought that the COVID-19 vaccine could reduce the spread of the disease in the community. In the multiple regression model, better socioeconomic status, holding nuclear families, and having a history of essential vaccinations uptake were linked with knowledge, while attitudes were substantially associated with being female and having a previous history of vital vaccines uptake. Conclusion: The results showed that medical students had sufficient knowledge, an optimistic attitude, and moderate levels of concern towards COVID-19. Vaccine hesitancy was much less among medical when compared to non-medical students. Expanding knowledge and regulatory oversight of vaccine research and the public release of safety data may lessen vaccine reluctance among students.

Cellulolytic enzymes have gained considerable importance as potential candidates for the efficient bioconversion of agricultural biomass into second-generation biofuel. This study aimed to improve cellulase production from a bacterial strain isolated from cow dung. The biochemical and molecular identification was performed, and the capacity of the isolated bacterium to hydrolyze sugarcane bagasse was also determined. Response surface methodology (RSM) and one-variable-at-a-time (OVAT) designs were employed to maximize the cellulase production. The bacterium identified as Bacillus subtilis gave the highest cellulase yield at temperature of 45 °C, pH-7.0, and 72 h of incubation time. Optimization by the Plackett–Burman design consisting of 12 experimental runs at two levels of nine independent variables displayed the significant contribution of galactose (22%) and sodium nitrate (16%) in cellulase production. The responses in the form of contour and 3D plots (generated by Box-Behnken design) predicted maximum cellulase production with an activity of 0.8 U/mL/min in a medium containing 3.0 g/L carboxymethyl cellulose, 3.0 g/L galactose, 0.5 g/L sodium nitrate, 0.75 g/L KH2PO4, and 0.375 g/L MgSO4·7H2O. The experimentally deduced activity value was 0.698 U/mL/min, showing 90% validity of the predicted value and gave a threefold increase in cellulase production. The process adequately represented by the quadratic model (p < 0.0343) for all the responses was significant. Results obtained show that optimization of fermentation medium favored the increased production of cellulase by the bacterium. The bacterial isolate B. subtilis CD001 was found to be a potential candidate to hydrolyze the lignocellulosic feedstock, sugarcane bagasse.

Emerging viruses causing Acute Encephalitis Syndrome (AES) can be more damaging due to irreversible brain damage, irrespective of the identical medical characteristics created by all agents. We report two cases of acute encephalitis syndrome caused by Japanese encephalitis virus from a usually under-reported geographic region of India. Both patients were managed conservatively with favourable outcome in one of them.There should be considerable effort to identify the particular causative agent that triggers AES, bearing in mind the various clinical manifestations of Japanese encephalitis virus. Although there is no significant impact on management, it is possible to prevent transmission to healthy contacts and the community through vector control and vaccination.

Introduction: Prevalence of asthma in children

Background: Aspergillosis is one of the most common fungal infection among both general patients and immunocompromised individuals. Methods: The study was carried out on 2 groups of patients: immunocompetent and immunocompromised comprising of a total of 90 patients. Microscopy, culture, identification of isolates was done and some specialised tests on serum and BAL for antigen detection were performed. Result: Most of the patients i.e., 47 (31.3%) were between 31-40 years with a mean age of 32.5 years. The male to female ratio was 1.8:1. Galactomannan antigen was positive in 13 (28.9%) BAL samples and in 15 (33.3%) serum samples wherein the 45 BAL samples represented immunocompetent cases and 45 serum samples represented immunocompromised cases. Sensitivity and specificity of GM assay in BAL samples were found to be 100% and 97% respectively. On the other hand, sensitivity and specificity in serum samples were found to be 94.1% and 100% respectively. All patients were categorized into 4 categories as proven IPA, probable IPA, possible IPA and non-IPA. 22 (24.4%) patients were of proven invasive pulmonary aspergillosis (IPA), 7 (7.8%) of probable IPA, 2 (2.2%) belonged to possible IPA while 59 (65.5%) were of non IPA. All of the cases of proven IPA were positive on culture. Conclusion: GM assay in BAL is a very sensitive and specific marker for Aspergillosis while in case of serum samples it is somewhat lesser sensitive.

Purpose: The pathogenicity in Candida spp was attributed by several virulence factors such as production of tissue damaging extracellular enzymes, germ tube formation, hyphal morphogenesis and establishment of drug resistant biofilm. The objective of present study was to investigate the effects of silver nanoparticles (AgNPs) on growth, cell morphology and key virulence attributes of Candida species. Methods: AgNPs were synthesized by the using seed extract of Syzygium cumini (Sc), and were characterized by UV-Vis spectrophotometer, Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), energy-dispersive X-ray (EDX), and transmission electron microscopy (TEM). ScAgNPs were used to evaluate their antifungal and antibacterial activity as well as their potent inhibitory effects on germ tube and biofilm formation and extracellular enzymes viz. phospholipases, proteinases, lipases and hemolysin secreted by Candida spp. Results: The MICs values of ScAgNPs were ranged from 0.125-0.250 mg/ml, whereas the MBCs and MFCs were 0.250 and 0.500 mg/ml, respectively. ScAgNPs significantly inhibit the production of phospholipases by 82.2, 75.7, 78.7, 62.5, and 65.8%; proteinases by 82.0, 72.0, 77.5, 67.0, and 83.7%; lipase by 69.4, 58.8, 60.0, 42.9, and 65.0%; and hemolysin by 62.8, 69.7, 67.2, 73.1, and 70.2% in C. albicans, C. tropicalis, C. dubliniensis, C. parapsilosis and C. krusei, respectively, at 500 μg/ml. ScAgNPs inhibit germ tube formation in C. albicans up to 97.1% at 0.25 mg/ml. LIVE/DEAD staining results showed that ScAgNPs almost completely inhibit biofilm formation in C. albicans. TEM analysis shows that ScAgNPs not only anchored onto the cell surface but also penetrated and accumulated in the cytoplasm that causes severe damage to the cell wall and cytoplasmic membrane. Conclusion: To summarize, the biosynthesized ScAgNPs strongly suppressed the multiplication, germ tube and biofilm formation and most importantly secretion of hydrolytic enzymes (viz. phospholipases, proteinases, lipases and hemolysin) by Candia spp. The present research work open several avenues of further study, such as to explore the molecular mechanism of inhibition of germ tubes and biofilm formation and suppression of production of various hydrolytic enzymes by Candida spp.

EmergingvirusescausingAcute EncephalitisSyndrome (AES)canbemoredamagingduetoirreversiblebraindamage,irrespectiveoftheidenticalmedicalcharacteristicscreatedbyallagents. We report two cases of acute encephalitis syndrome caused by Japanese encephalitis virus from a usually under-reported geographic region of India. Both patients were managed conservatively with favourable outcome in one of them.There should be considerable effort to identify the particular causative agent that triggers AES, bearing in mind the various clinical manifestations of Japanese encephalitis virus. Although there is no significant impact on management, it is possible to prevent transmission to healthy contacts and the community through vector control and vaccination. &nbsp

The pathogenicity of Candida species in human is dependent on a variety of virulence factor such as adhesion factors, germ tube and hyphal formation, secretion of hydrolytic phospholipases and proteinases and drug resistance biofilm. ZnO NPs have been synthesized by using leaf extract of Crinum latifolium and were characterized by UV-Vis spectrophotometer, FTIR, SEM, EDX and TEM. In this study for the first time, potent inhibitory effects of ZnO NPs on principal virulence factors of Candida albicans and non-albicans such as germ tube formation, secretion of hydrolytic phospholipases and proteinases and biofilm formation has been investigated. ZnO NPs remarkably reduced the germ tube formation of C. albicans at 1 (86.4%), 0.5 (75.0%), 0.25 (61.4%), 0.125 (34.1%) and 0.062 mg/ml (11.4%). ZnO NPs significantly lowered the phospholipase and proteinase secretion by 58.8 and 95.2% at 0.25 mg/ml, respectively. CSLM results showed that ZnO NPs suppressed biofilm formation up to 85% at 0.25 mg/ml. SEM and TEM micrograph showed that ZnO NPs penetrated inside the cell and causes extensive damaged in cell wall and cell membrane. Inhibition of Candida growth and various virulent factors by ZnO NPs provides an insight towards their therapeutic application for the treatment of Candida-associated infections.

The occurrence of microbial communities harboring antibiotic resistance bacteria and antibiotic resistance genes in the drinking water distribution system pose a significant threat to the aquatic ecosystem and to public health, especially in developing countries. In this study, we have used next-generation sequencing technology to explore bacterial community diversity and the abundance of antibiotic resistance genes in biofilms collected from the drinking water distribution system of Peshawar, the capital city of the Khyber Pakhtunkhwa province of Pakistan. The results showed that Proteobacteria were the most abundant phyla (89.79%) in all biofilm samples, followed by Bacteroidetes (3.48%) and Actinobacteria (2.79%). At genus level, Pseudomonas was the most common (22.45%) in all biofilm samples. Overall, bacterial diversity and richness was higher in biofilm samples collected from the consumer end than the source site. Bacterial diversity was also dependent on the piping material (GI vs. PVC) and water supply (direct vs. indirect). Functional annotation reveals a differential abundance of common metabolic pathways at source and consumer end. Resistome analysis revealed a prevalence of resistance genes against 12 classes of antibiotics in all samples with macrolides resistance being the commonest at the consumer end (42.1%) and fluoroquinolone resistance at the source end (24%). To our knowledge, this is the first study that provides new insight and evidence into the microbial community diversity and antibiotic resistance in the drinking water supply system of Peshawar. These findings may ultimately help the authorities to design and implement effective strategies for controlling biofilms and ensuring a continuous supply of safe drinking water to the community.

Nanoparticles (NPs) prepared through safer, eco-friendly and natural-based products can be used various applications including antimicrobial and biomedical applications. Quorum sensing (QS) is a complex system for intercellular communication that regulates the expression of many virulence determinants, in the opportunistic Pseudomonas aeruginosa. Thus, the disruption of QS-mediated communication system could be an alternative strategy to combat infection caused by drug resistant P. aeruginosa. In this study, zinc oxide nanoparticles (ZnO NPs) were synthesized by using seed extract of Butea monosperma and further characterized by XRD, SEM and TEM. The biosynthesized ZnO NPs were then subjected to the investigation of their antibacterial, antibiofilm activities as well as the anti-quorum sensing potentialities for biomedical applications. The minimum inhibitory concentration (MIC) value against P. aeruginosa was found 1600 µg/ml, and it was found that ZnO NPs effectively reduced virulence factors Viz. swarming and swimming of P. aeruginosa by 62.8 and 45%, respectively. Exopolysaccharides production was also affected by ZnO NPs which indicate the disruption of biofilm formation. Further, the in silico docking analysis displayed that ZnO NPs efficiently interacted within QS (Las/Rhl) mechanism of P. aeruginosa by binding to the catalytic cleft of LasI synthase (Gly-116-ZnO = 2.8 A), RhlI synthase (Gly-180-ZnO = 3.7 A) and transcription receptor protein LasR receptor (Asn-141-ZnO = 2.9 A), RhlR receptor (Tyr-72-ZnO = 2.6 A). Thus, it was concluded that the effective interaction of ZnO NPs with Las and Rhl system led to the inactivation of autoinducers such as N-acyl homoserine lactones (AHL) molecules which finally led to the inactivation of QS and down regulation of virulence determinants. Consequently, the present in vitro and in silico results obtained suggest that the synthesized ZnO NPs can be efficiently used as potent antimicrobial agents to prevent the colonization, biofilm formation as well as anti-QS-mediated determinants caused by pathogenic drug resistant bacteria.

Green synthesized nanoparticles have gained great attention due to their non-toxic and non-hazardous nature. In the present study, bark extract of the medicinal plant in Ayurveda Crataeva nurvala (Buch-Ham) (CN) was chosen for the biosynthesis of silver nanoparticles (AgNPs). These NPs were characterized by Ultra violet visible spectroscopy, Fourier Transform Infra Red, Atomic Force Microscopy, and Transmission Electron Microscopy (TEM). The average particle size of green synthesized CN-AgNPs was 15.2 ± 1.01 nm. Gas chromatography- mass spectrometry analysis of methanolic bark extract involved in the formation of CN-AgNPs revealed lupeol as a major active component. In this study, CN-AgNPs (15 μg ml-1 ) efficiently suppressed the production of quorum sensing mediated virulence factors viz. pyocyanin, protease, hemolysin, and biofilm formation in Pseudomonas aeruginosa. The pyocyanin production was strongly inhibited (74.64%) followed by proteolysis (47.3%) and hemolysin production (47.7%). However, the biofilm forming ability was maximally reduced up to 79.70%. Moreover, the Confocal Laser Scanning Microscopic Analysis showed that CN-AgNPs inhibit colonization of P. aeruginosa on to the surface. Furthermore, TEM analysis revealed internalization of CN-AgNPs inside the bacterial cell. It is concluded that green synthesized AgNPs have great potential to inhibit virulence factors and biofilm forming ability of drug-resistant clinical isolates of P. aeruginosa.

The present study deals with the intraperitoneal administration of 500, 1000, 3000, and 5000mg/kg of AgNPs in albino mice for 28 days to evaluate the potential toxicological effects of AgNPs on blood biochemical parameters and to investigate the light and electron microscopic histopathological alterations on three major targets organs i.e., liver, kidney and spleen. The AgNPs was well tolerated and no mortality was observed even at the highest dose i.e., 5000mg/kg. Mice treated with 500 and 1000mg/kg AgNPs did not show significant behavioral, biochemical and ultrastructural pathological changes. Mice treated with 1000mg/kg AgNPs produces little ultrastructural alteration in liver, kidney and spleen. However, mice treated with 3000 and 5000mg/kg AgNPs revealed significant changes in biochemical parameters. Electron microscopic ultrastructural investigation of liver and kidney shows that the administration of 3000 and 5000mg/kg AgNPs revealed irregularity in the nuclear membrane, nuclear chromatin condensations, degenerated hepatocytes, swollen and pleomorphic mitochondria with distorted cristae, extensive dilation of rough endoplasmic reticulum, destructed cytoplasm, hypertrophied and fused podocytes and thickened basement membrane in the endothelial cells of the proximal tubules. The spleen sections at 3000 and 5000mg/kg AgNPs revealed megakaryocytes hyperplasia, lobulations, invaginations and folding of nuclei and nuclear membrane. The present research indicates that AgNPs were well tolerated at the lower doses, but significant alterations in liver, kidney and spleen were observed at the higher doses tested. It is, therefore, suggested that further studies are needed for the minimization of the observed side effects, especially at higher doses before AgNPs being applied in pharmaceutical application.

Eco-friendly and cost effective Al2O3 NPs were synthesized by a green method using a leaf extract of Cymbopogon citratus. The characterization of the synthesized NPs was performed by XRD, HR-TEM, EDS, AFM, DLS, and zeta potential. To our knowledge, for the first time, the antifungal activity of Al2O3 NPs against various Candida spp isolated from oropharyngeal mucosa of HIV+ patients has been investigated. The antifungal potential of Al2O3 NPs has been assessed by determining minimum inhibitory concentrations (MIC), minimum fungicidal concentration (MFC), growth kinetics, and well diffusion methods. The minimum concentration at which Al2O3 NPs inhibit the growth of Candida spp were 250–500 μg ml−1 and more or less no growth has been observed at higher concentration (i.e., 1500 μg ml−1) when incubated for 48 h. The mechanisms of Al2O3 NPs–Candida cell biointerface interaction and its intracellular localization were further characterized by SEM and HR-TEM. The electron microscopic analysis shows that Al2O3 NPs not only attach to the surface but also penetrate inside the Candida cells and disrupt the morphological as well as physiological activity that led to the death of the cells. Due to the scavenging potential of Al2O3 NPs, the antifungal activity of Al2O3 NPs is mild towards tested yeast spp and that is why these NPs suppressed the growth of yeast cells at higher concentration. The result obtained in this study shows that Al2O3 NPs inhibit the growth of fluconazole susceptible and fluconazole resistant C. albicans and C. dubliniensis in a similar manner regardless of their drug resistant mechanisms. Thus, the present study revealed that Al2O3 NPs may be a promising remedy for the development of anticandidal agents and play an important role for sustained controlled drug delivery in medical implants and for therapeutic coatings on implantable devices used in orthopedics and dentistry.

Background: Urinary tract infection (UTI) is one of the most common bacterial infections, affecting 150 million people each year worldwide with substantial clinical and financial burden. With upcoming multi drug resistance (MDR) and carbepenem resistance among uropathogens there is urgent need to explore other new or old treatment options like nitrofurantoin and fosfomycin trometamol.Methods: This is a cross-sectional (descriptive study) conducted over 6 month’s period from October 2019 to March 2020. Out of 9045 urine samples, 1788 (19.8%) were positive (1721 samples with single organism and 67 samples with 2 organisms). Total 1855 isolates were identified and antimicrobial susceptibility was performed by Kirby-Bauer method and VITEK 2 system. Methicillin‑resistant Staphylococcus aureus (MRSA), vancomycin resistant enterococci (VRE), multi drug resistance (MDR) and metallo‑beta‑lactamases (MBL) production was detected.Results: E. coli 41.8% was found commonest followed by enterococcus species (21.6%). Methicillin resistance was 66% while 1.8% were VRE. 429 (34.5%) were CRE (carbapenem resistant enterobacteriales) out of which, 154 (36%) were MBL while 188 (44%) were detected as serine carbapenemase producers via modified carbapenem inactivation method (mCIM) and EDTA-modified carbapenem inactivation method (eCIM) testing. Among 742 (40%) MDR, fosfomycin was effective in 611 (82.3%) while 331 (77.1%) of the CRE isolates were susceptible to fosfomycin.Conclusions: Fosfomycin should be reserved for MDR and nitrofurantoin should be used cautiously otherwise resistance will increase to these drugs in the coming days.

Synthesis of nanoparticles using the plants has several advantages over other methods due to the environmentally friendly nature of plants. Besides being environmentally friendly, the synthesis of nanoparticles using plants or parts of the plants is also cost effective. The present study focuses on the biosynthesis of zinc oxide nanoparticles (ZnO NPs) using the seed extract of Butea monsoperma and their effect on to the quorum-mediated virulence factors of multidrug-resistant clinical isolates of Pseudomonas aeruginosa at sub minimum inhibitory concentration (MIC). The synthesized ZnO NPs were characterized by different techniques, such as Fourier transform infra-red spectroscopy (FTIR), scanning electron microscopy (SEM), energy dispersive X-ray (EDX), and transmission electron microscopy (TEM). The average size of the nanoparticles was 25 nm as analyzed by TEM. ZnO NPs at sub MIC decreased the production of virulence factors such as pyocyanin, protease and hemolysin for P. aeruginosa (p &le, 0.05). The interaction of NPs with the P. aeruginosa cells on increasing concentration of NPs at sub MIC levels showed greater accumulation of nanoparticles inside the cells as analyzed by TEM.

Plant-based synthesis of eco-friendly nanoparticles has widespread applications in many fields, including medicine. Biofilm&mdash, a shield for pathogenic microorganisms&mdash, once formed, is difficult to destroy with antibiotics, making the pathogen resistant. Here, we synthesized gold nanoparticles (AuNPs) using the stem of an Ayurvedic medicinal plant, Tinospora cordifolia, and studied the action of AuNPs against Pseudomonas aeruginosa PAO1 biofilm. The synthesized AuNPs were characterized by techniques such as ultraviolet-visible spectroscopy, Fourier-transform infrared (FTIR) spectroscopy, energy-dispersive X-ray diffraction, X-ray diffraction, scanning electron microscopy (SEM), and transmission electron microscopy. The AuNPs were spherically shaped with an average size of 16.1 nm. Further, the subminimum inhibitory concentrations (MICs) of AuNPs (50, 100, and 150 &micro, g/mL) greatly affected the biofilm-forming ability of P. aeruginosa, as observed by crystal violet assay and SEM, which showed a decrease in the number of biofilm-forming cells with increasing AuNP concentration. This was further justified by confocal laser scanning microscopy (CLSM), which showed irregularities in the structure of the biofilm at the sub-MIC of AuNPs. Further, the interaction of AuNPs with PAO1 at the highest sub-MIC (150 &micro, g/mL) showed the internalization of the nanoparticles, probably affecting the tendency of PAO1 to colonize on the surface of the nanoparticles. This study suggests that green-synthesized AuNPs can be used as effective nano-antibiotics against biofilm-related infections caused by P. aeruginosa.

Development of multidrug resistance among pathogens has become a global problem for chemotherapy of bacterial infections. Extended-spectrum β-lactamase- (ESβL-) producing enteric bacteria and methicillin-resistant Staphylococcus aureus (MRSA) are the two major groups of problematic MDR bacteria that have evolved rapidly in the recent past. In this study, the aqueous extract of Murraya koenigii leaves was used for synthesis of silver nanoparticles. The synthesized MK-AgNPs were characterized using UV-vis spectroscopy, FTIR, XRD, SEM, and TEM, and their antibacterial potential was evaluated on multiple ESβL-producing enteric bacteria and MRSA. The nanoparticles were predominantly found to be spheroidal with particle size distribution in the range of 5–20 nm. There was 60.86% silver content in MK-AgNPs. Evaluation of antibacterial activity by the disc-diffusion assay revealed that MK-AgNPs effectively inhibited the growth of test pathogens with varying sized zones of inhibition. The MICs of MK-AgNPs against both MRSA and methicillin-sensitive S. aureus (MSSA) strains were 32 μg/ml, while for ESβL-producing E. coli, it ranged from 32 to 64 μg/ml. The control strain of E. coli (ECS) was relatively more sensitive with an MIC of 16 μg/ml. The MBCs were in accordance with the respective MICs. Analysis of growth kinetics revealed that the growth of all tested S. aureus strains was inhibited (∼90%) in presence of 32 μg/ml of MK-AgNPs. The sensitive strain of E. coli (ECS) showed least resistance to MK-AgNPs with >81% inhibition at 16 μg/ml. The present investigation revealed an encouraging result on in vitro efficacy of green synthesized MK-AgNPs and needed further in vivo assessment for its therapeutic efficacy against MDR bacteria.

Objectives: Detection and comparison of metallo-β-lactamase (MBL) production in clinical isolates by phenotypic and genotypic measures. The objective of this study is to evaluate clinical characteristics and risk factors in patients infected with MBLs. Materials and Methods: Study was conducted by the Department of Microbiology, Jawaharlal Nehru Medical College from February 2014 to December 2015. Bacterial culture, identification, and antibiotic susceptibility were carried out according to standard guidelines. MBL production was detected both phenotypically (Modified Hodge test [MHT], imipenem-ethylene diamine tetraacetic acid double disk potentiation test [IMP-EDTA DDPT], IMP-EDTA combined disk synergy test [IMP-EDTA CDST]), and genotypically (bla NDM-1, bla VIM and bla IMP). Results: Among 116 carbapenem-resistant Gram-negative Bacilli (CRGNB), Citrobacter species 28 (24.1%) was the most common pathogen. Phenotypically, MHT, IMP-EDTA DDPT, and IMP-EDTA CDST detected MBL production in 105 (90.5%), 96 (81%), and 87 (75%) CRGNB, respectively. Bla NDM-1 genes were detected in 6 6 (56.8%) isolates, however, very few bla VIM (16, 15.2%) and bla IMP (1, 1.2%) were identified. Considering polymerase chain reaction (PCR) as the gold standard, it was observed that IMP-EDTA CDST was most specific (78.3%) while MHT was most sensitive (97.4%). Results of bla NDM-1 gene by PCR were further confirmed by sequencing (Triyat genomics, Nagpur). All the 11 representative strains were confirmed to be NDM-1 gene. Major risk factors in patients infected with MBLs were in-dwelling devices (68%), prolonged hospital stay (72%) and prior antibiotic treatment (86%). However, on tracing their outcome, it was interesting to note that mortality was relatively low 5 (4.3%). Conclusion: The present study shows a rising trend of bla NDM-1 in CRGNB, an ominous sign heralding the post antibiotic era. It is essential to assess the prevalence of various MBLs so that infection control measures can be reinforced. We recommend three phenotypic tests in tandem for the detection of MBL. While phenotypic tests are easy and cost-effective to perform, quick, effective molecular diagnostic techniques can tailor treatment guidelines to optimize patient's management.

This study attempted to elucidate the spectrum of sexually transmitted infections in a tertiary care centre in North India and to assess the antimicrobial resistance in Neisseria gonorrhoeae.Antimicrobial resistance pattern of N. gonorrhoeae was determined by the standard techniques. Genotypic detection of gyrA, parC and blaTEM genes was also carried out. The results of gyrA gene by polymerase chain reaction were confirmed by DNA sequencing.N. gonorrhoea was identified in 10 (4.98%) patients, and antimicrobial sensitivity was performed in seven patients. All the seven patients tested were quinolone-resistant N. gonorrhoeae (QRNG), 5/7 were penicillinase-producing N. gonorrhoeae, 1/7 was chromosomally mediated penicillin-resistant N. gonorrhoeae and 3/7 were tetracycline-resistant N. gonorrhoeae. Minimal inhibitory concentration (MIC) by E-test was performed in five strains, and we observed that MIC90 for ciprofloxacin was ≥4 μg/ml, for penicillin was ≥6 μg/ml and for tetracycline was 12 μg/ml, which clearly brackets them as resistant isolates. The presence of TEM gene was confirmed genotypically in six out of seven cases. In all seven cases, gyrA and parC were observed, thus confirming their QRNG status.Alarming increase in the resistance to commonly used antimicrobials for gonorrhoea in our study, especially of fluoroquinolones, is a clarion call for the urgent need for prudence in prescribing them. Observing the rampant resistance exhibited by N. gonorrhoeae, it is clear that the day is not far when it will acquire a superbug status and become intractable to treatment by the available antibiotics.

The objective of the present study was one step extracellular biosynthesis of silver nanoparticles (AgNPs) using supernatant of Candida glabrata isolated from oropharyngeal mucosa of human immunodeficiency virus (HIV) patients and evaluation of their antibacterial and antifungal potential against human pathogenic bacteria and fungi. The mycosynthesized AgNPs were characterized by color visualization, ultraviolet-visible (UV) spectroscopy, fourier transform infrared spectroscopy (FTIR), and transmission electron microscopy (TEM). The FTIR spectra revealed the binding and stabilization of nanoparticles with protein. The TEM analysis showed that nanoparticles were well dispersed and predominantly spherical in shape within the size range of 2–15 nm. The antibacterial and antifungal potential of AgNPs were characterized by determining minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC)/ minimum fungicidal concentration (MFC), and well diffusion methods. The MBC and MFC were found in the range of 62.5–250 μg/mL and 125–500 μg/mL, which revealed that bacterial strains were more susceptible to AgNPs than fungal strains. These differences in bactericidal and fungicidal concentrations of the AgNPs were due to the differences in the cell structure and organization of bacteria and yeast cells. The interaction of AgNPs with C. albicans analyzed by TEM showed the penetration of nanoparticles inside the Candida cells, which led the formation of “pits” and “pores” that result from the rupturing of the cell wall and membrane. Further, TEM analysis showed that Candida cells treated with AgNPs were highly deformed and the cells had shrunken to a greater extent because of their interaction with the fungal cell wall and membrane, which disrupted the structure of the cell membrane and inhibited the normal budding process due to the destruction and loss of membrane integrity and formation of pores that may led to the cell death.

Five week-old mice were divided into a vehicle control group, and groups exposed to ZnO nanoparticles at low (0.5 g/kg), middle (1 g/kg), high (3 g/kg), and exceptionally high-dose (5 g/kg). After the first, second, third, and fourth weeks’ of exposure, blood biochemistry, histopathology, and electron microscopic ultrastructural changes in liver, kidney and spleen were investigated. Increased alkaline phosphatase activities were observed in all treated mice being statistically significant at higher dose. No changes were observed in the serum glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, creatinine, blood urea nitrogen, and lipid levels. During the first and second weeks of the treatment, effects on the cytoarchitecture of liver, kidney, and spleen were not perceived while during the third and fouth weeks of treatment sporadic mild effects were seen. Ultrastructural electron microscopic changes in liver, kidney, and spleen were not observed for the low-dose group on the first, sec...

Four-week-old mice, weighing about 25-35 g were divided into five groups (8 mice in each group): vehicle control, low- (0.5 g/kg), middle- (1 g/kg), high- (3 g/kg), and exceptionally high-dose (5 g/kg). After first and second weeks of intraperitoneal exposure to AgNPs, biochemical, histopathological, and electron microscopic ultrastructural changes were investigated. No significant changes were observed in SGOT and ALP levels after first week of exposure, while the level of SGPT significantly increased (p

Introduction: Tuberculosis (TB) remains a significant public health problem with an estimated onethird of the world’s population being infected. Cytokines play a major role in protection against Mycobacterium tuberculosis infection and regulate the immune responses at cellular level. Most studies on cytokines during TB are from ‘in vitro’-stimulated lymphoid cells with few reports on in vivo plasma levels. This study was aimed to evaluate the levels of TNF-α & IL4 in new, underOriginal Research Article Fatima et al.; BMRJ, 7(4): 159-166, 2015; Article no.BMRJ.2015.107 160 treatment (UT) and multidrug resistant (MDR) pulmonary and extra-pulmonary cases. Methodology: The study was conducted at the Department Of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India. Levels of TNF-α and IL-4 were measured in 76 serum samples from TB patients by ELISA kit (Diaclone France) along with 10 BCG vaccinated control. A complete clinical, radiological & treatment data was collected on questionnaire forms of each patients. Results: TNF-α levels were elevated in new (P 0.05). TNF-α and IL-4 levels showed no significant variations according to site of involvement in pulmonary vs. extra-pulmonary TB cases. Conclusion: An understanding of the development of this response may lead to insight into pathogenesis and novel therapies for TB.

Article history: Received on: 07/07/2015 Revised on: 21/07/2015 Accepted on: 09/08/2015 Available online: 28/10/2015 Emergence of AmpC beta-lactamases in isolates of Pseudomonas and Acinetobacter species, is a threatening condition as they mediate resistance to a wide variety of β-lactam drugs, including α-methoxy-β-lactams, such as cefoxitin, narrow-, expanded- and broad-spectrum cephalosporins, aztreonam and are poorly inhibited by βlactam inhibitor combinations. The present study was conducted to determine the occurrence of blaampC genes in these pathogenic non-fermenters for their rapid and accurate detection. Monoplex PCR was done to detect blaampC genes in 40 non-duplicate clinical Pseudomonas and Acinetobacter isolates, that were found resistant to any of the third-generation cephalosporin and cefoxitin. Multiplex PCR assay was carried out to identify family-specific AmpC beta-lactamase genes within Pseudomonas and Acinetobacter spp. PCR detected blaampC in 43.24% of Pseudomonas and 33.33% of Acinetobacter isolates. Overall 42.50% of the total isolates were found to harbour blaampC genes by PCR. By multiplex PCR, total eight (20%) isolates yielded a positive amplicon with AmpCspecific primers. High prevalence of blaampC genes in cefoxitin-resistant isolates of Pseudomonas and Acinetobacter isolates emphasizes that molecular detection methods should be carried out to know the exact prevalence of beta-lactamases.

A condensation reaction between 1,2-diphenylethane-1,2-dione dihydrazone (DPEDDH) and dimethyl or diethyloxalate in methanol resulted in a novel Schiff base octaazamacrocyclic ligand, (L): (6,7,14,15-tetraoxa-2,3,10,11-tetraphenyl-1,4,5,8,9,12,13,16-octaazacyclohexadecane-1,3,9,11-tetraene). Subsequently metal complexes of the type [MLX2] and [CuL]X2; (M = Mn(II), Co(II), Ni(II) and Zn(II); X = Cl or NO3) were synthesized by the reaction of the free macrocyclic ligand (L) with the corresponding metal salts in 1:1 molar ratio. These complexes were characterized on the basis of analytical data, molar conductivity and magnetic susceptibility measurements, ESI-mass, IR, NMR (1H and 13C), EPR and electronic spectral studies. The thermal stability of the complexes was also studied by TGA and DTA analyses. These studies show that all the complexes have octahedral arrangement around the metal ions except copper complexes which are square planar. The ligand and its complexes were screened for their antibacterial activity in vitro against Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria and were also studied for their anticancer activity against the human cancer cells lines: HeLa (Human cervical carcinoma), MCF7 (Human breast adenocarcinoma) and Hep3B (Human Hepatocellular carcinoma). The recorded IC50 values for the tested compounds show moderate to good cytotoxicity against these cancer cell lines. The copper complex, [CuL]Cl2, showed excellent antimicrobial activity against tested microorganisms which is almost equivalent to the standard drug ciprofloxacin.

Background: Chronic Suppurative Otitis Media (CSOM) is an important cause of preventable hearing loss. Global emergence of resistant strains is of great concern. The aim of the present study was t o determine the etiology and antibiotic sensitivity pattern of bacterial isolates from CSOM cases with special emphasis on ESBL (Extended Spectrum Beta- Lactamases) and AmpC beta lactamases. Methods: Patients with sign and symptoms suggestive of CSOM, ESBL (Extended Spectrum Beta-Lactamases), AmpC beta lactamases and MBLs (Metallo beta lactamases) were included. Two ear swabs were taken from all the patients and cultured on blood agar and MacConkey agar. Bacterial identification of isolates was done using standard biochemicals. Antimicrobial susceptibility was performed by Kirby-Bauer's disc diffusion method as per the Clinical Laboratory Standards Institute (CLSI) guidelines using antibiotic discs (HI MEDIA). Results: Out of 130 patients, 110(84.62%) had bacterial growth. The common pathogenic species were Pseudomonas aeruginosa 36(37.89%), Staphylococcus aureus 31(32.63%), Citrobacter koseri 9(9.47%) and Proteus vulgaris 6(6.32%). P. aeruginosa showed maximum sensitivity to colistin (94.4%), polymixin-B (91.3%) and imipenem (91.3%) . Gram positive cocci showed maximum sensitivity to vancomycin (99%). MRSA (Methicillin Resistant Staphylococcus aureus) and HLAR (High Level Aminoglycoside Resistance) were detected in 9(29%) S. aureus and 1(50%) Enterococcus faecalis respectively. ESBL and AmpC were detected in 11 (18.3%) and 12(20%) Gram negative bacteria, respectively and MBL producer was not detected. Conclusion: P. aeruginosa was found to be the most common isolate in CSOM cases and colistin, polymixin-B and imipenem was found to be most effective antibiotics.

Pseudomonas aeruginosa an opportunistic pathogen regulates its virulence through Quorum sensing (QS) mechanism comprising of Las and Rhl system. Targeting of QS mechanism could be an ideal strategy to combat infection caused by P. aeruginosa. Silver nanoparticles (AgNPs) have been broadly applied as antimicrobial agents against a number of pathogenic bacterial and fungal strains, but have not been reported as an anti-QS agent. Therefore, the aim of present work was to show the computational analysis for the interaction of AgNPs with the QS system using an In silico approach. In silico studies showed that AgNPs got ‘locked’ deeply into the active site of respective proteins with their surrounding residues. The molecular docking analysis clearly demonstrated that AgNPs got bound to the catalytic cleft of LasI synthase (Asp73-Ag = 3.1 Å), RhlI synthase (His52-Ag = 2.8 Å), transcriptional receptor protein LasR (Leu159-Ag = 2.3 Å) and RhlR (Trp10-Ag = 3.1 Å and Glu34-Ag = 3.2 Å). The inhibition of LasI/RhlI synthase by AgNPs blocked the biosynthesis of AHLs, thus no AHL produced, no QS occurred. Further, interference with transcriptional regulatory proteins led to the inactivation of LasR/RhlR system that finally blocked the expression of QS-controlled virulence genes. Our findings clearly demonstrate the anti-QS property of AgNPs in P. aeruginosa which could be an alternative approach to the use of traditional antibiotics for the treatment of P. aeruginosa infection.

Cefotaximases (CTX-M), temoniera (TEM), and sulfhydryl variable (SHV) constitute a rapidly growing cluster of enzymes that have disseminated geographically. They are spreading to species other than Enterobacteriaceae and might be responsible for the presence of blaCTX-M,blaTEM, and blaSHVgenes in Pseudomonas and Acinetobacter spp. The present study was designed to characterize CTX-M, TEM, and SHV phenotypically and genotypically in Pseudomonas and Acinetobacter spp.A total of 90 isolates (73 Pseudomonas and 17 Acinetobacter spp.), resistant to any of the third-generation cephalosporins, were randomly selected from clinical samples.Of 90 isolates, 64 (71.11%) were tested positive for extended-spectrum β-lactamase (ESBL) production. Among phenotypically tested ESBL producers, forty isolates were randomly selected for molecular characterization. The prevalence of CTX-M, TEM, and SHV was found to be 57.5%, 15%, and 75%, respectively. Multiplex polymerase chain reaction assay categorized blaCTX-Mgenes into Groups 1 and 26 where Group 1 was present in only 5 isolates and Group 25 was present in rest of the 18 isolates.This is among the premier systemic reports from India documenting phenotypic and molecular characterization of CTX-M, TEM, and SHV β-lactamases in Pseudomonas and Acinetobacter spp. With judicious use of antibiotics and strict infection control procedures, it may be possible to limit the effects of these newer β-lactamases.

The experiment was designed to evaluate the effect of sheep manure (SM), its application timing (AT) and N fertilizer (urea) on dry matter partitioning and harvest index. The study was conducted on RCBD split plots arrangement at Agronomic research farm during 2015. Sheep manure (SM1=3 t ha-1, SM2=4 t ha-1, SM3=5 t ha- 1) and application timing (AT1=15 days before sowing, AT2=At sowing time) were allotted to main plots however, fertilizer N (N1=0 kg ha-1, N2= 90 kg ha-1, N3=120 kg ha-1) were applied to sub-plots. Application of 5 t ha-1 of sheep manure at 15 days before sowing significantly enhanced pre-tasseling (stem and leaves) and physiological maturity (stem, leaves, cobs and grains) dry matter partitioning and harvest index. Pre-tassel and physiological maturity dry matter accumulation were higher with application of 120 kg N ha-1 however, Application of 5 t sheep manure ha-1 at 15 days before sowing and 120 kg N ha-1 was recommended for higher dry matter accumulation of maize crop.

Advanced glycation end products are major contributors to the pathology of diabetes, Alzheimer's disease, and atherosclerosis; accordingly, identification of antiglycation compounds is attracting considerable interest. In the present study, the inhibitory effect of gum arabic capped-silver nanoparticles on advanced glycation end products formation was monitored by several biophysical techniques. Silver nanoparticles were characterized by ultraviolet-visible, high-resolution transmission electron microscopy, and energy-dispersive X-ray spectroscopy. Bovine serum albumin and methylglyoxal mixtures incubated with increasing concentrations of silver nanoparticles showed significant reductions in advanced glycation end product formation that were confirmed by ultraviolet-visible, fluorescence spectrometry, and high-performance liquid chromatography techniques. High-performance liquid chromatography showed decreased adduct formation of glycated protein in the presence of silver nanoparticles. The structural changes induced by silver nanoparticles were further confirmed by circular dichroism and Fourier transform infrared spectroscopy. Strong inhibition of advanced glycation end product formation was observed in the presence of elevated silver nanoparticles. The results of this study suggest that silver nanoparticles are a potent antiglycating agent.

Clinical isolates (n = 55) of Pseudomonas aeruginosa were screened for the extended spectrum β-lactamases and metallo-β-lactamases activities and biofilm forming capability. The aim of the study was to demonstrate the antibiofilm efficacy of gum arabic capped-silver nanoparticles (GA-AgNPs) against the multi-drug resistant (MDR) biofilm forming P. aeruginosa. The GA-AgNPs were characterized by UV-spectroscopy, X-ray diffraction, and high resolution-transmission electron microscopy analysis. The isolates were screened for their biofilm forming ability, using the Congo red agar, tube method and tissue culture plate assays. The biofilm forming ability was further validated and its inhibition by GA-AgNPs was demonstrated by performing the scanning electron microscopy (SEM) and confocal laser scanning microscopy. SEM analysis of GA-AgNPs treated bacteria revealed severely deformed and damaged cells. Double fluorescent staining with propidium iodide and concanavalin A-fluorescein isothiocyanate concurrently detected the bacterial cells and exopolysaccharides (EPS) matrix. The CLSM results exhibited the GA-AgNPs concentration dependent inhibition of bacterial growth and EPS matrix of the biofilm colonizers on the surface of plastic catheters. Treatment of catheters with GA-AgNPs at 50 µg ml(-1) has resulted in 95% inhibition of bacterial colonization. This study elucidated the significance of GA-AgNPs, as the next generation antimicrobials, in protection against the biofilm mediated infections caused by MDR P. aeruginosa. It is suggested that application of GA-AgNPs, as a surface coating material for dispensing antibacterial attributes to surgical implants and implements, could be a viable approach for controlling MDR pathogens after adequate validations in clinical settings.

Background: Genotypically, hepatitis B virus (HBV) is divided into 8 groups, A–H. The interaction between HBV replication and immune responses against HBV infection plays an important role in the pathogenesis of virus infection. Aims and Objectives: In an attempt to elucidate the role of immunomodulatory, pro-inflammatory, and anti-inflammatory mediators in the pathogenesis of HBV genotype D fulminant hepatitis (FH), we assessed the role of interferon gamma (IFN-γ), tumor necrosis factor-α (TNF-α), and interleukin-10 (IL-10) in such patients. Subjects and Methods: Two hundred and seventy-six cases of acute hepatitis among which 37 cases of fulminant hepatic failure were screened. A genotyping system based on polymerase chain reaction using type-specific primers was used in this study (Sami et al. 2013). TNF-α, IL-10 levels, and IFN-γ serum level were measured by ELISA. Results: Genotype D was detected in 10 cases (27.02%) out of 37 FH patients. Mean IL-10, IFN-γ, and TNF-α levels in FH patients were significantly higher than the healthy controls at 127.6 ± 73.45 pg/ml (P < 0.001), 10.6778 ± 5.23 pg/ml (P < 0.0001), and 62.9000 ± 21.67 pg/ml (P < 0.001), respectively. IFN-γ and IL-10 levels were much higher in cases of hepatitis B e-antigen (HBeAg) seronegative individuals, mean levels being 20.77 pg/ml and 36.53 pg/ml, respectively. Using multiple linear regression analysis, the presence of HBeAg was inversely associated with TNF-α. Conclusion: This study clearly highlights the excessive dysregulated response of the three cytokines, more so of IL-10 which appears pivotal in the pathogenesis of FH. Interventions leading to suppression of IL-10 levels may be beneficial in improving the patient outcome.