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Introduction: Candidemia is a major cause of morbidity and mortality in hospitalized patients, especially pediatric population, justifying the importance of adequate antifungal therapy. Immunocompromised patients, preterm neonates, elderly patients and patients admitted to intensive care units are at higher risk of invasive candidiasis infections. A shift has been observed in the relative frequency of non-albicans Candida (NAC) and Candida albicans in blood stream infections. Studies on the prevalence of infections and antifungal susceptibility testing can help with deciding on clinical strategies to manage this problem. Aims and Objectives: The following study was performed to find the prevalence of various Candida species causing candidemia and their resistant pattern in Aligarh region of western Uttar Pradesh. Materials and Methods: Two thousand and eighty-four samples for blood culture were received in the microbiology laboratory over a period of 5 months. Seventy-one positive samples for Candida were identified and tested for antifungal susceptibility testing by Vitek-2 (21) and conventional methods (50). Results: 3.41% of the blood culture were positive for Candida species. Candida tropicalis (35.21%) was the most common species isolated followed by Candida glabrata (21.13%), C. albicans (14.08%), Candida krusei (9.86%), Candida pelliculosa (9.86%), Candida parapsilosis (4.23%), Candida guilliermondii (4.23%), and Candida utilis (1.41%). Maximum percentage of isolates were from neonates (47.89%) followed by infants (25.35%). Resistance to fluconazole and amphotericin B was seen in 11.27% and 1.41% of isolates. Conclusion: NAC species outnumbering C. albicans even as single most common species in candidemia patient isolates is alarming. Fluconazole is generally used as empirical therapy. NAC being more resistant and some being intrinsically resistant (C. krusei) to fluconazole strengthens the need of antifungal susceptibility testing on priority basis.

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.

Introduction: Invasive fungal infections are increasingly common in the nosocomial setting. Materials and Methods: The patients were divided into two groups immunocompetent and immunocompromised that is, patients with significant neutropenia

Objective To elucidate the antifungal activity of silver nanoparticles on the clinical isolates of Candida albicans and to compare the performance of silver nanoparticles with the conventional antifungals Materials and methods nbsp Sample size The present study was carried out in the Department of Microbiology JNMCH AMU patients were included in the study Samples were collected according to their clinical presentation Identification of Candida species It was done as per the standard protocol Testing of conventional antifungals susceptibility by i Disc diffusion ii Broth microdilution method Evaluation of antifungal activity of Silver nanoparticles and Comparision of its performance by i Well diffusion ii Broth microdilution iii Turbidometry method Results In samples Candida albicans were isolated Most of these isolates were resistant to either Azoles Nystatin or Amphoteracin B and of them were resistant to all But they formed zones of inhibition with varying concentrations of silver nanoparticles AgNP in well diffusion method confirming antifungal activity of AgNPs On comparing the MIC of AgNP and other conventional antifungals revealed very low MIC of AgNP micro g ml as compared to fluconazole micro g ml and caspofungin micro g ml Conclusion Silver nanoparticles have more potent antifungal activity in vitro on the resistant Candida albicans isolates nbsp

BACKGROUND: Oral submucous fibrosis (OSMF) is a chronic, premalignant condition of the oral mucosa and one of the commonest potentially malignant disorders amongst the Asian population. The objective of this study was to investigate the association of etiologic factors with: age, frequency, duration of consumption of areca nut and its derivatives, and the severity of clinical manifestations. METHODS: A cross-sectional, multi centric study was conducted over 8 years on clinically diagnosed OSMF cases (n = 765) from both public and private tertiary care centers. Sample size was determined by World Health Organization sample size calculator. Consumption of areca nut in different forms, frequency of daily usage, years of chewing, degree of mouth opening and duration of the condition were recorded. Level of significance was kept at P ≤ 0.05. RESULTS: A total of 765 patients of OSMF were examined, of whom 396 (51.8%) were male and 369 (48.2%) female with a mean age of 29.17 years. Mild OSMF was seen in 61 cases (8.0%), moderate OSMF in 353 (46.1%) and severe OSMF in 417 (54.5%) subjects. Areca nut and other derivatives were most frequently consumed and showed significant risk in the severity of OSMF (P ≤ 0.0001). Age of the sample and duration of chewing years were also significant (P = 0.012). CONCLUSIONS: The relative risk of OSMF increased with duration and frequency of areca nut consumption especially from an early age of onset.

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.

Background Aspergillus antigens such as galactomannan antigen, a cell wall polysaccharide, can be detected in patient’s serum or bronchoalveolar lavage. To study the prevalence of Aspergillus infection in patients with bronchogenic carcinoma, we measured galactomannan antigen in serum and bronchoalveolar lavage samples of patients with bronchogenic carcinoma. Methods The study was conducted on 45 bronchogenic carcinoma patients. The diagnosis of lung cancer was confirmed by bronchoscopy, histopathological and radiological examinations. Bronchoalveolar lavage fluid collected from each patient by fiberoptic bronchoscopy was subjected to direct microscopy and culture on Sabouraud’s dextrose agar and Czapek-Dox agar, and Aspergillus galactomannan antigen was measured in serum and bronchoalveolar lavage samples. Results The majority of patients were male (93.3%) in the age group 51–60 years, 88.9% were addicted to gutka chewing, and 82.1% were addicted to smoking. Most patients complained of cough (73%) and shortness of breath (51.1%). Squamous cell carcinoma (64.4%) was the most common malignancy, followed by adenocarcinoma (13.3%). On culture of bronchoalveolar lavage samples, 35.5% showed growth of Aspergillus spp. ( Aspergillus fumigatus in 17.8%, Aspergillus flavus in 13.3%, and Aspergillus niger in 4.4%). Galactomannan antigen was detected in 58.3% of bronchoalveolar lavage samples and 47.2% of serum samples. Conclusions There is a high prevalence of aspergillosis in patients with lung carcinoma, especially among smokers and gutka chewers.

BACKGROUND: Cryptosporidium has emerged as one of the major parasitic agents as a cause of diarrhoea in children. Various epidemiological factors have been described by different workers. Aims: This study was done to determine different epidemiological factors incriminated in cryptosporidiosis. Methods: Stool samples from 240 children with diarrhoea were examined for presence of Cryptosporidium. Wet mount examination, modified Ziehl- Neelsen (Z.N.) and Safranine-methylene blue staining methods were performed. For 177 samples, ELISA was also done. Detailed history of patients regarding their socioeconomic status and various sociodemographic factors was taken. Statistical Analysis: Chi-square and z tests were used to compare differences between the groups. A p value of ≤0.05 was considered significant. Results: Majority of patients were in Class IV socioeconomic group. Top-feeding, use of insanitary wells for drinking purposes, close association with animals, field defaecation and residence in rural areas were different factors that contributed to the spread of infection. Oocysts were present in 21 children on different staining procedures and 23 were positive by ELISA. Conclusion: Different sociodemographic factors like improper sanitation practices, drinking contaminated water, early withdrawal of breast feeding and close intimacy with animals are various factors that can enhance the spread of infection in community. Preventive measures are of great importance in control of spread of infection as there is no specific therapy for cryptosporidiosis.

AIM: The aim of current research was to find out the sealing ability of two commonly used sealers in the presence and absence of smear layer at different time interval. MATERIAL AND METHODS: Total of 180 single rooted vital teeth were used. Transversal section was made with the help of digital slow speed cutting saw to divide the root and crown part. After removal of crown roots part was instrumented and prepared. The 180 teeth were randomly divided into two equal groups (n=90) 1 and 2. In group 1 the smear layer was kept intact but it was removed from group 2 with EDTA (17%). Group 1 was then divided into two sub-groups, A1, A2. Group 2 was again separated into two sub-groups, B1 and B2. Each sub-group contained of 45 samples. In sub-groups A1 and B1, AH Plus sealer, in sub-groups A2 and B2, Ketac-endo sealer and cold lateral condensation technique was used for obturation with gutta percha. All samples were kept in an incubator at 37°C for 24 hours, with help of nail polish/varnish all samples root surfaces was painted only excluding apical area after words each sub group were further divided in to three groups of 15 to represent immersion periods of 7,15 and 30 days. All samples were then kept in 5 % methylene blue dye solution at 37o c for their respective time periods. After specific time period, the roots of every group were cut longitudinally and evaluate under a stereomicroscopes to evaluate apical micro leakage in millimeter. Data was subjected to Repeated measure ANOVA with post-hoc analysis using Tukey and bonferroni tests. RESULTS: Overall analysis indicated significant reduction in sealing ability canals in with and without smear layer over different time periods (p

Hydatid disease remains a serious health problem in Mediterranean countries. Living in a rural area is an important risk factor for the disease. Hydatid cysts are usually located in the liver, lungs and brain. Mediastinal hydatid disease is very rare and has been noted only anecdotally in the literature. The present article reports a case of a mediastinal hydatid cyst rupturing into the pleural cavity, which was associated with pneumothorax of the same side. The patient’s previous chest x-rays (posteroanterior and left lateral views) showed a well-defined mediastinal mass on the left side, and contrast-enhanced computed tomography of the thorax (taken a few days after the chest x-ray) showed multiple round-to-oval soft tissue opacities with partial collapse of the left lung. An indirect hemagglutination test for echinococcus was positive. Even after two weeks of intercostal tube drainage, the patient’s condition did not improve. During thoracotomy, multiple daughter cysts were found in the pleural cavity, and the diagnosis of a hydatid cyst was confirmed after histopathological examination.

Introduction: Mycobacterium tuberculosis (Mtb) infects one third of the world population. Despite advance in therapy, tuberculosis (TB) remains responsible for 2-3 million deaths annually. During TB, cytokines play a role in host defense. Many cytokines are produced during TB with a predominance of Th1 cytokines during the early stage and Th2 cytokines in the later stages of the infection. The present study aims to screen tumor necrosis factor-alpha (TNF-α), interferon gamma (IFN-γ), interleukin (IL)-12p70, IL-4, IL-6, and IL-1β among TB patients and controls. Materials and Methods: The study was conducted at the Department Of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India. Different cytokine levels were measured in 65 samples of TB patients of whom 30 (46.1%) were new TB cases and 35 (53.8%) were suspected multidrug-resistant (MDR)-TB cases along with 15 bacille Calmette-Guerin (BCG) vaccinated healthy controls by enzyme-linked immunosorbent assay (ELISA) (Diaclone, France). Complete clinical, radiological, and treatment data were collected. Informed consent was taken from all subjects. Study was approved by the Institutional Bioethical Committee, Jawahar Lal Nehru Medical College. Statistical analysis had been performed by using Sigma plot (10.0). Results: The serum concentration of TNF-α, IFN-γ, IL-12p 70 , IL-1β, and IL-6 in patients with active TB and MDR-TB was elevated than in patients after anti-TB treatment (P < 0.001), in contacts (P < 0.001) and in controls (P < 0.001). It was found that IL-6 seems critical in resistance to TB. IL-4 concentration increased only in MDR-TB patients (P < 0.001) as compared to controls. All these cytokines showed no significant variations according to the site of involvement in pulmonary versus extrapulmonary TB cases. Conclusions: Measuring the serum levels of several cytokines may be useful for evaluating the activity of TB disease and monitoring the clinical effects of anti-tubercular treatment (ATT). The serum TNF-α, IFN-γ, IL-12p 70 , IL-1β and IL-6 level can be a useful marker to diagnose the effectiveness of therapy in the patients.

Objectives: This study aimed to develop a novel model for detection of extended spectrum beta-lactamase (ESBL), AmpC and metallo-betalactamase (MBL) producing Serratia and Citrobacter species using cefoperazone sulbactam as well as other inducer-substrate combinations in a disc approximation assay. In the absence of molecular tools in developing countries, we attempted to standardize simple phenotypic techniques for detection of beta-lactamases to allow effective patient care in our countries. These techniques have been scarcely used in Serratia and Citrobacter spp., which are emerging as significant pathogens in our region. Methodology: Clinical isolates of Serratia and Citrobacter were tested for ESBL production. Cefoperazone (CP)/cefoperazone sulbactam (CPS), piperacillin (PIP)/piperacillin-tazobactam (TZP) and ceftazidime (CAZ)/ceftazidime-clavulanic acid (CAZ-CLAV) combinations were compared for their ability to detect ESBL producers phenotypically. Multi-drug resistant strains were further tested for detection of inducible/derepressed AmpC mutants by a disc approximation assay. Isolates were screened for MBL production by Imipenem (IMI). MBL production was confirmed using Ethylenediaminetetraacetic acid (EDTA) in a double disc synergy assay and Hodge test. Minimal inhibitory concentration (MIC) was performed for CP, CPS and IMI by agar dilution method for all isolates of Serratia and Citrobacter spp. Results: Thirty-three percent of isolates of Serratia spp. and 35.4% of Citrobacter spp. were ESBL producers. CPS was a more sensitive inducer of ESBL than TZP and CAZ/CAZ-CLAV. AmpC producers were detected in 25.6% of the isolates of Serratia spp. (40% inducible and 60% derepressed mutants) and in 35.4% of the isolates of Citrobacter spp. (33% inducible and 66% derepressed mutants). Six isolates (four class B and two class A) of Serratia and eight isolates (seven class B and one class A) of Citrobacter spp. were MBL producers. Multiple mechanisms co-existed in eight isolates of Serratia and 15 isolates of Citrobacter spp. CPS was more effective in identifying ESBLs and inducible AmpC producers as well as type 1 carbapenemases than TZP and CAZ-CLAV were able to identify inducible AmpC producers. Conclusions: The high prevalence of ESBL, AmpC, and MBL in Serratia and Citrobacter species in this study suggests that detection of these by phenotypic methods in the absence of more specific molecular tests should be actively considered in not only developing countries but also in the developed world as this approach can lead to timely and appropriate antibiotic treatment. CPS may be advised due to the triple advantage of detection of all three types of beta-lactamases.

Stomatococcus mucilaginosus is a Gram-positive, catalase-variable organism considered part of the normal human oral and upper respiratory tract flora. Although traditionally believed to be an organism of low virulence, Stomatococcus mucilaginosus has been reported to be an opportunistic pathogen in immunocompromised patients. We describe what we believe is the first reported case of Stomatococcus mucilaginosus meningitis in a healthy child. The isolate was multidrug-resistant, susceptible only to vancomycin. The patient was treated successfully with vancomycin after initial trials with amikacin and cefotaxime.

Introduction: Tuberculosis (TB) remains a significant public health problem, with an estimated one-third of the world's population being infected. Cytokines play a major role in protection against Mycobacterium tuberculosis ( M. tuberculosis ) infection and regulate the immune responses at a cellular level. Most studies on cytokines during TB are from in vitro -stimulated lymphoid cells with few reports on in vivo plasma levels. The aim of this study was to evaluate the levels of tumor necrosis factor-α (TNF-α) in new, undertreatment (UT), and multidrug-resistant (MDR) pulmonary and extrapulmonary cases. Materials and Methods: The study was conducted in the Department of Microbiology, Jawaharlal Nehru Medical College (J.N.M.C.), Aligarh Muslim University (A.M.U.), Aligarh, Uttar Pradesh, India. Results: The levels of TNF-α were measured in 76 serum samples from TB patients by an enzyme linked immunosorbent assay (ELISA) kit (Diaclone Sas, 1 BD, A Flemming Besancon Cedax, France), along with 10 healthy controls. Complete clinical, radiological and treatment data were collected. The TNF-α levels were elevated in new cases ( P P P > 0.05). Conclusions: An understanding of this response may lead to an insight into the pathogenesis and novel therapies for TB.

Mycobacterium tuberculosis (Mtb) infects approximately one third of world population. Many cytokines are produced during tuberculosis, with predominance of Th1 cytokines during the early stage and Th2 cytokines in the later stages of the infection. Most studies on cytokines during TB are from ‘in vitro’-stimulated lymphoid cells with few reports on in vivo plasma levels. The high expression of IL-4 has been implicated as a virulence factor. In the present study we examined the level of IL-4 in the serum of active tuberculosis in new cases, during anti-tubercular therapy and MDR cases. This Study was conducted at Department Of Microbiology, JNMC, AMU, Aligarh. A total 76 blood samples of Pulmonary & Extra-Pulmonary tuberculosis patients were tested by ELISA (Diaclone France) along with 10 healthy controls. The test was carried out according to the manufacturer instructions. O.D. was taken at 450 nm. There was no stastical difference in age and sex in our study. The level of IL-4 show significant changes in MDR TB cases (P 0.05). An understanding of the development of the cellular immune response may lead to insight into pathogenesis and novel therapies for TB. Further studies are needed to address the role of cytokines in immunity to TB under natural conditions.

Background: With increasing incidence of resistance to antibiotics carbapenems are used as the last resort because they are stable even in response to extended spectrum and AmpC beta-lactamases. However, Gram-negative bacilli producing the acquired metallo-beta-lactamases (MBL) are on the rise. Aim: The aim of the following study is to detect phenotypically the presence of extended spectrum beta-lactamase (ESBL), AmpC and MBL in Gram-negative bacteria isolated from clinical specimen. Materials and Methods: Gram-negative isolates from clinical samples were screened and confirmed for the presence of ESBLs by double disk synergy test (DDST), for AmpC by disk approximation assay and for MBL by Modified Hodge Test and imipenem-ethylenediaminetetraacetic acid DDST. Results: Among 251 isolates studied, 138 (54.98%) were ESBL producers, 49 (19.52%) were AmpC producers and 45 (17.93%) were MBL producers. Highest rates of ESBL detection was by Cefoperazone sulbactam (109/138) 78.98%. Out of 92 of the AmpC producing strains 20 (21.73%) were inducible and 72 were stably derepressed (78.26%). Out of 251 strains studied 45 (17.93%) were phenotypically identified as MBL producers, the highest no. being of Pseudomonas aeruginosa. Among the methods employed for detection of MBL production, Hodge test (62.22%) proved better than DDST (40%). Conclusions: High level of antibiotic resistance pattern exists in various clinical isolates. ESBL production should be looked for routinely in Gram-negative bacteria other than Escherichia coli and Klebsiella. A high percentage of derepressed AmpC mutants are noteworthy and alarming. We recommend phenotypic identification methods as routine practice in laboratories as genotypic methods are not cost-effective.

Purpose: To examine the effect of apple and orange juices on the surface hardness of direct tooth-colored restorative materials. Materials and methods: The materials included resin-modified glass ionomer cement (Vitremer 3M™ ESPE™ Core buildup restorative) and composite resin (Filtek™ 3M™ ESPE™ Z350). A total of 45 disks of each restorative material were prepared. The disks were divided into groups of 15, which were immersed for 7 days in deionized water (G1/G4, control group), apple juice (G2/G5), or orange juice (G3/G6). The pH of the apple juice was approximately 4.8 and the pH of the orange juice was approximately 4.9. Surface hardness tests were performed before immersion and at various times following immersion. Statistical analysis included two-way ANOVA with repeated measurement and Tukey’s test. Results: Exposure to juices significantly reduced the hardness of both materials (p