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Diabetes mellitus, type 1 in particular, is a well-recognised risk factor for melioidosis, a disease caused by Burkholderia pseudomallei. Melioidosis is endemic in Southeast Asia and in northern Australia and has a variety of clinical presentation, isolated splenic abscess being one of them. B. pseudomallei, however, is an uncommon aetiology of splenic abscess. The diagnosis of melioidosis is often overlooked unless the clinician and the microbiologist are suspicious of the condition. Multiple splenic abscesses and perisplenic collection were noted in CT scan of the abdomen in a patient of type 1 diabetes, presenting with fever for preceding 4 weeks. B. pseudomallei was isolated from the splenic aspirate and the diagnosis was made based on gram stain and routine biochemical tests. He was successfully treated with antibiotics. We postulate that the likely route of infection was inoculation through skin, the integrity of which was compromised by multiple subcutaneous insulin injections.

Timely administration of appropriate empirical antibiotics in febrile neutropenia is crucial for favourable patient outcomes. There are guidelines in place recommending such antibiotics. However, regional variations and local epidemiological data must be evaluated to tailor the antibiotics for best possible and rational use. In this study, we audited the clinical and microbiological data of febrile neutropenic episodes occurring at a tertiary care haematology institution. Three hundred and ninety-three febrile neutropenic episodes occurring in 123 patients over a 1-year period were analysed for microbial profile, sensitivity and resistance patterns, and finally clinical outcomes. Gram-negative bacilli (GNB) blood stream infections (46.9%) were more prevalent as compared to gram-positive infections (41.9%). Overall mortality due to complicated neutropenic sepsis was 19.5% (24/123 patients). Increased resistance to carbapenems, beta-lactam beta-lactamase inhibitor combinations, aminoglycosides, fluoroquinolones, and cephalosporins were observed. Cefepime and tigecycline resistance were seen in 20% and 15% GNB isolates, respectively. Chest was the most frequent focus of infection, and acute myeloid leukaemia (AML) was the most common underlying disorder which correlated with the likelihood of death (p < 0.01). Multidrug-resistant GNB (esp. Klebsiella sp.) are still most worrisome isolates in neutropenic patients. Single-agent cefepime or piperacillin-tazobactam/tigecycline combination may be considered empirical agents. Chest infections and AML were independent predictors of poor clinical outcome in neutropenic patients. Regular audit of infections and antibiotic susceptibility data is needed to improve clinical outcomes in patients with febrile neutropenia.

Background: Hepatitis C virus (HCV) is the primary etiologic agent of liver cirrhosis or hepatocellular carcinoma. HCV elevated infection rates are mostly due to the lack of an accurate and accessible screening and diagnosis, especially in low- and middle-income countries. Proper strategy will improve actual screening and treatment programs and help to reach HCVelimination. Methods: This cross-sectional study consist of 103 subjects were included in our study who attended Dept of Microbiology, Medical College, Kolkata for anti HCV antibody detection. These include various groups who are at high risk of exposure to HCV and also low risk population between February 2018 and November 2018. A predesigned and pretested questionnaire was used to collect data and the data was summarized using descriptive statistics. Template was generated in MS excel sheet and analysis was done on SPSS 20.0 software. Results: Out of the 103 patients, 59.2% were male and 40.8% were female. Among 64 patients who were HCV-ELISAreactive only 24 were found to be having HCV-RNAin their blood 37.5%. Specicity of ELISAwas 56.52%. Specicity of ELISAand TRIDOTcombined was 100%. Among 2 IDU patients positive by ELISA(both were negative in TRI-DOT). HCV-RNAcould be found in one (01). Positive predictive value of ELISAin this group in 50%. Conclusions:Combination of ELISA& Tri dot assay plays an import role to detect active HCVinfection among patients.

Candidemia is the fourth common cause of blood stream infection worldwide leading to increased mortality and morbidity. A paradigm shift of Candida albicans to Non-albicans candida (NAC) had led to the increase in resistance to empirically used antifungals. So, an epidemiological study and antifungal susceptibility is essential for meticulous use of antifungals.To find out the prevalence and antifungal susceptibility of Candida species causing candidemia.automated blood culture done in BACTEC system followed by its identification and susceptibility testing in VITEK-2 system.Non-albicans candida was isolated from 73% cases of candidemia. The commonest isolate among neonates and adults were C.krusei and C.tropicalis respectively. C.haemulonii was significantly high among adult population while C.krusei was significantly high among the neonates. 10.4% NAC isolates were resistant to amphotericin B, flucytosine resistance among 37% NAC isolates and among 44% C.albicans isolates, fluconazole resistance was found among 13% and 15% of NAC and C. albicans respectively. Echinocandins were comparatively sensitive to the candida spp.

Stroke and infection have a close relationship! There is possibly interplay of inflammation with traditional risk factors of stroke such as hypertension, hyperlipidemia, diabetes, and smoking. Ricketssiae infection is already known to have multisystemic involvement. Stroke, both ischaemic and hemorrhagic though rarely reported to be associated with this infection often resulted in drastic consequences. Here, we will present a case where a gentleman who presented with stroke following a rickettsia infection only few days after he was thrombolysed for an initial event. We probably managed to avoid a catastrophe by treating the infection at earliest! Key Messages: Infection may interact with traditional risk factors of stroke and may precipitate a vascular event. Epidemiological knowledge of existing infections in community, early detection and intervention may prevent complications even if stroke is precipitated. Keywords: Ricketssiae, Postthrombolysis, Stroke.

A 45-year-old farmer presented with intermittent high-grade fever associated with anorexia, dull-aching abdominal pain over left upper quadrant and a documented weight loss of around 20 kg over the preceding 1 year. He had been advised antitubercular therapy 6 months prior to his presentation

PurposeDysregulated immune response is a key driver of disease progression in sepsis and known to be associated with impaired cellular metabolism. This association has been studied mostly in the late stage sepsis patients. Here, we investigate whether such impairment in cellular metabolism is present in uncomplicated infection patients who do not develop sepsis.MethodsForty sepsis (fulfilled Sepsis-3 criteria) and 27 uncomplicated infection patients were recruited from the emergency department along with 20 healthy volunteers. Whole blood was collected for measurement of gene expression, cytokine levels and cellular metabolic functions (including mitochondrial respiration, oxidative stress and apoptosis).ResultsOur analysis revealed the impairment of mitochondrial respiration in uncomplicated infection and sepsis patients (p value ConclusionsThese findings suggest that impaired immune cell metabolism is present in infection patients without presenting sepsis, thereby opening potential window for early diagnosis and intervention (e.g. antioxidant therapy) in such patients.

Diabetes mellitus, type 1 in particular, is a well-recognised risk factor for melioidosis, a disease caused by Burkholderia pseudomallei. Melioidosis is endemic in Southeast Asia and in northern Australia and has a variety of clinical presentation, isolated splenic abscess being one of them. B. pseudomallei, however, is an uncommon aetiology of splenic abscess. The diagnosis of melioidosis is often overlooked unless the clinician and the microbiologist are suspicious of the condition. Multiple splenic abscesses and perisplenic collection were noted in CT scan of the abdomen in a patient of type 1 diabetes, presenting with fever for preceding 4 weeks. B. pseudomallei was isolated from the splenic aspirate and the diagnosis was made based on gram stain and routine biochemical tests. He was successfully treated with antibiotics. We postulate that the likely route of infection was inoculation through skin, the integrity of which was compromised by multiple subcutaneous insulin injections.

Background/objectives Mitochondrial dysfunction occurs in vital organs in experimental acute pancreatitis (AP) and may play an important role in determining severity of AP. However, obtaining vital organ biopsies to measure mitochondrial function (MtF) in patients with AP poses considerable risk of harm. Being able to measure MtF from peripheral blood will bypass this problem. Furthermore, whether mitochondrial dysfunction is detectable in peripheral blood in mild AP is unknown. Therefore, the objective was to evaluate peripheral blood MtF in experimental and clinical AP. Method Mitochondrial respiration was measured using high resolution oxygraphy in an experimental study in caerulein induced AP and in a separate study, in patients with mild AP. Superoxide, cytochrome c , mitochondrial membrane potential (ΔΨ) and adenine triphosphate (ATP) were also measured as other markers of MtF. Results Even though some states of mitochondrial respiration were increased in both experimental and clinical AP, this did not lead to an increase in net ATP in patients with AP. The increased leak respiration in both studies was further proof of dyscoupled mitochondria. In the clinical study there were also features of mitochondrial dysfunction with increased leak flux control ratio, superoxide, ΔΨ and decreased cytochrome c . Conclusion There is evidence of mitochondrial dysfunction with dyscoupled mitochondria, increased superoxide and decreased cytochrome c in patients with mild acute pancreatitis. Further studies should now determine whether mitochondrial function alters with severity in AP and whether mitochondrial dysfunction responds to treatments.

A 25-year-old unmarried woman, resident of a filarial endemic region, presented with progressive swelling of the vulva along with recent onset redness, dragging pain and consequent difficulty in walking. She had noticed the vulval swelling about 2 years before her presentation and had been suffering from recurrent episodes of low-grade fever for the preceding 2 years. The swelling had been reducible initially and became non-reducible after about 6 months. She denied any pelvic surgery, radiation or trauma. Her medical and family histories were unremarkable. A thorough systemic examination did not document any abnormality. Genital examination revealed non-ulcerative bilateral vulval swelling with bosselated surface, hard in consistency with raised local temperature and palpable bilateral superficial inguinal lymph nodes (figure 1). Baseline work-up was as follows: haemoglobin 11 g/dL, total leucocytes count 7000 cells/mm3, neutrophil 60%, lymphocytes 20%, eosinophil 12% and erythrocyte sedimentation rate (ESR) 60 mm in first hour. Peripheral blood collected at midnight examined by concentration technique using Leishman stain was negative for microfilaria. However, immunochromatographic test for microfilarial antigen was …

INTRODUCTION: Serratia marcescens is a member of the Entero bactereacae family. S. marcescens is widely distributed in nature. It is isolated as saprophytes from soil and water. Reports of nosocomial infections caused by S. marcescens have increased in recent years. Infections include UTI, RTI, Septicaemia, Meningitis and Endotoxic shock. Only small proportion (

OBJECTIVE To isolate microRNAs (miRNAs) from mesenteric lymph (ML) and peripheral blood and identify those that change with experimental acute pancreatitis (AP). To assess identified AP-associated miRNAs in patient plasma to evaluate them as clinical biomarkers of AP. BACKGROUND miRNAs, small non-protein-coding molecules that regulate gene expression, are present in many biological fluids. They are increasingly interesting as biomarkers of disease and as novel signaling molecules in pathogenesis. METHODS Affymetrix miRNA profiling was performed on ML collected from 3 groups of rats with either mild or moderate taurocholate-induced AP and sham controls. Quantitative reverse transcription-polymerase chain reaction was used to validate selected miRNAs in matched rat lymph and plasma and then measured in patients with mild or moderate AP and in healthy volunteers. RESULTS Eighty-five miRNAs were detectable in rat ML, and many were abundant in all animals irrespective of the presence of AP. Seven miRNAs, comprising miR-375, -217, -148a, -216a, -122, -214, and -138, were increased in ML from rats with AP (P < 0.01). Their abundance also altered with disease severity. miRNAs miR-217, -375, -122, and -148a were also increased in matched rat plasma samples by quantitative reverse transcription-polymerase chain reaction. In the clinical studies, plasma miR-216a was significantly increased in both mild and moderate AP. CONCLUSIONS This study is the first to demonstrate both the presence of circulating miRNAs in lymph and the alteration of specific miRNAs in AP. Furthermore, these miRNAs alter in rat and human AP plasma and have potential to be explored as novel biomarkers of pancreatitis.

We have isolated Salmonella Typhi from blood culture of ten cases of Enteric fever within a period of three months at Calcutta School of Tropical Medicine. The individual cases were from different geographical areas. Case 2, Case 5 and case 7 were from Dumdum. Isolation of ten cases within such a short period of three months between March, April & May 2014 prompted us to report them.

A 36-year-old man had been diagnosed with type 2 diabetes and put on twice daily premixed insulin for severe hyperglycaemia and osmotic symptoms about 3 months prior to his presentation to us. He was injecting himself with U-40 insulin syringe subcutaneously over anterior abdomen with proper technique and regular rotation of the injection sites. After about 2 months after starting insulin he had noticed multiple firm nodules appearing over the injection sites. The nodules were painless, became fluctuant over the course of time and used to burst spontaneously with discharge of pus. He had been put on several courses of oral antibiotics over the previous 2 months without any symptomatic relief. Some of the swellings required incision and drainage of the underlying pus. Gram stain and both aerobic and anaerobic culture of the drained pus were negative on multiple occasions. A thorough systemic examination did not reveal any abnormality. Complete blood count including erythrocyte sedimentation rate was normal. Mantoux test with 5 tuberculin unit was negative. Histopathological examination of the scrapings from abscess wall revealed …

Background & Aims There is no consistency between the individual studies in the literature on whether organ failure (OF) or infected pancreatic necrosis (IPN) is the main determinant of severity in acute pancreatitis. We aimed to statistically aggregate the available data and determine the pooled influence of OF and IPN on mortality in patients with acute pancreatitis. Methods The search for relevant observational studies was undertaken in the MEDLINE, EMBASE, and Scopus electronic databases, as well as in the proceedings of major gastroenterology meetings. The summary estimates are presented as relative risk (RR) and 95% confidence interval (CI). Results Fourteen studies comprising 1478 patients with acute pancreatitis were meta-analyzed. A total of 600 patients developed OF and 179 of them died (mortality, 30%); 314 patients developed IPN and 102 of them died (mortality, 32%). In a stratified analysis, patients with OF and IPN had a significantly higher risk of death in comparison with patients with OF and no IPN (RR = 1.94; 95% CI: 1.32−2.85; P = .0007) and in comparison with patients with IPN and no OF (RR = 2.65; 95% CI: 1.30−5.40; P = .0007). Conclusions In patients with acute pancreatitis, the absolute influence of OF and IPN on mortality is comparable and thus the presence of either indicates severe disease. The relative risk of mortality doubles when OF and IPN are both present and indicates extremely severe disease or critical acute pancreatitis.

A 12-year-old boy presented with high grade intermittent fever for 15 days with polyarthralgia involving the large joints of his extremities for last 5 days. His parents also noticed appearance of a pinkish coloured non-pruritic rash on the back of the trunk about a week after the onset of fever which resolved spontaneously only to reappear on the extensor surface of his right leg in the morning of the day of presentation. On examination, the patient was febrile with an oral temperature of 102 °F. The large joints of his extremities were not swollen but were tender on palpation. The rash was non-tender and non-pruritic, having elevated and reddened edges with a flat and clear centre (Fig. 1). Rest of the systemic examination was normal except sinus tachycardia. Complete blood count was normal except for raised ESR (90 mm), C-reactive protein (53 mg/L) and Anti-streptolysin O titre (754 IU). EKG was done and it revealed sinus tachycardia only. Trans-thoracic echocardiography documented thickened mitral valve leaflets with mild mitral regurgitation. Throat culture grew Streptococcus pyogenes. The patient was diagnosed to have acute rheumatic fever (ARF) based on the revised Jones criteria, treated symptomatically and was advised prophylactic benzathine penicillin G for secondary prevention until adulthood. Fig. 1 Erythematous annular papule over right lower limb with central clearing and serpentines spreading edges. Erythema marginatum, a form of annular erythema, is very uncommon in children experiencing the first attack of ARF [1]. The typical lesions have central clearing and serpenginous spreading edges and often are unnoticed by the patient or parent because they are painless and non-pruritic. It becomes even more difficult to detect the rash in dark-skinned people, explaining its rare occurrence (less than 1%) in ARF patients in non-white populations [2], [3]. Fever triggers the development of this rash, which perhaps explains the evanescent nature of the rash. Physicians should be careful not to overlook this rare but useful clinical manifestation of ARF, particularly in patients with subclinical valvular involvement to avoid potential late cardiac complications.

s for potentially relevant articles and these wereobtained in full text for closer inspection. The final selec-tion of articles was based on the following criteria:1. Published in English after 1990.2. Study results not duplicated in earlier publications.3. A significant proportion of study participants (>60%)were students enrolled in a medical program.4. Study results identified factors that influence studentintentions to pursue a career in surgery, and in partic-ular, general surgery. Studies that focused on interestin surgical specialties were included, given that thisalways included general surgery, but those that focusedon only 1 surgical subspecialty other than generalsurgery (eg, orthopaedics, urology, cardiothoracic,vascular) were excluded. No standard definitions wereapplied to the terms surgery and surgical specialties.5. If participants included women and men, study inves-tigators analyzed the data by sex to identify sex-specificfactors and draw separate conclusions about womenand men.Data management techniquesData extractionA standardized data extraction and critical appraisalinstrument was constructed by the investigators usingan electronic spreadsheet (Microsoft Excel Mac OS X2008, Microsoft Corporation) for the purpose of thisreview and included the following sections andcomponents:1. Study introduction: research objectives and rationale.2. Study context: study setting, details of study partici-pants, description of medical program.3. Study methods and materials: study design, participantrecruitment and sampling, study duration and follow-up, method(s) of data collection, psychometric proper-ties of data collection instruments, resources used, anddata analysis.4. Study results: main study findings, measures of func-tional significance (effect size, proportion of variance),attendance and drop-out rates.5. Discussion of study results: significance and practicalimplications of study findings, study strengths andlimitations, guidance on future research topics.6. Study conclusions.7. Appraisal for risks of bias: recruitment or selectionbias, data analysis and interpretation bias, incompleteand selective reporting bias, other sources of bias.Each selected article was analyzed independently by atleast 2 investigators (TY, AJ, and MC) and data wereextracted using the instrument described above.Data analysisDiscrepancies in opinions between 2 investigators wereidentified and final consensus was reached through face-to-face discussions and mediation by the other investiga-tors. The investigators analyzed study methodologies,defined common themes from study findings, and triedto find chronologic patterns in their occurrence. Selectedstudies were divided into 2 groups: those published beforeand during the year 2000 and those published after 2000.Career-influencing factors directly reported by studentparticipants were differentiated from factors that wereidentified indirectly through means such as data correla-tion and association analysis.

The present paper extends the branching process model [4] to cover linear ranking selection and binary tournament selection in genetic algorithms. Under certain simplifying assumptions, we derive the probability that a given class would vanish from the population by a given generation. No crossover or mutation is considered. Simulation results are presented.

Background: Mitochondrial dysfunction occurs in the pancreas and in extra-pancreatic organs early in experimental acute pancreatitis (AP). However, direct measurement of mitochondrial function (MtF) within these organs is not possible in clinical settings. Aims: To measure and describe changes in MtF in peripheral blood in experimental and clinical AP. Patients & methods: MtF was measured in peripheral blood mononuclear cells (PBMC) bymeasuringoxygenflux through the electron transport system(ETS) in anexperimental anda clinical study.MeasurementofMtFwas done in rats (n1⁄418) with caerulein induced mild AP (CAP) and in patients (n1⁄418) admittedwith predictedmild tomoderate AP. In both studiesMtFwas compared with appropriate controls. Mitochondrial superoxide production, cytochrome c, mitochondrial membrane potential (âˆy a a), and adenine triphosphate (ATP) were also measured in the clinical study. Results: MtF was successfully measured in the PBMC fraction of blood. The most significant alteration in MtF was increased endogenous respiration and leak respiration in both studies. The clinical study also revealed significant increases in mitochondrial superoxide and mitochondrial membrane potential and a decrease in cytochrome c but no change in total cell ATP content. Conclusion: This is the first study tomeasure changes in peripheral blood MtF inAP.MtF inPBMCwasaltered inboth theexperimental andclinical acute pancreatitis settings. Further studies should now investigate the time course of peripheral changes in MtF to explore whether it correlates with disease severity, end organ dysfunction and as an outcome predictor in AP.