Background and Aim: Foot ulcers are a significant complication of diabetes mellitus and are usually poly-microbial. Aerobic Gram-negative bacilli are isolated in higher frequency with increasing grade of ulcers, and development of drug resistance is a cause of concern. The aim of our study is to identify the extended spectrum β-lactamases (ESBL) and AmpC β-lactamases among the Gram-negative aerobic bacterial isolates in the different grades of diabetic foot ulcers. Materials and Methods: Pus samples from 104 male and female diabetic patients presenting with grade I to grade V foot ulcers were cultured according to the standard microbiological procedures and antimicrobial sensitivity performed by the Kirby-Bauer disc diffusion method as per CLSI guidelines. MIC ₅₀ of all isolates for Ceftazidime was detected by the agar dilution method. The Gram-negative bacterial isolates were further tested for ESBL and AmpC β-lactamases by the modified double disc synergy test and combined disc method. AmpC disc test was used for the confirmation of AmpC production. Results: Forty-seven isolates exhibited resistance to Ceftazidime phenotypically and 54 isolates had MIC greater than 2 μg/mL. ESBL production was observed in 55.55% of the isolates. AmpC production was seen in 19 isolates (35.18%). No mechanism of cephalosporin resistance was explainable for 5 isolates. Conclusion: The combined disc method was more sensitive in the detection of ESBLs, while the AmpC disc test was an easy way to detect AmpC beta lactamases and can be used for routine screening.

Background and Aim: Prevalence of sexually transmitted infections (STIs) shows regional variations. Various epidemiological studies report a diminishing prevalence of syphilis including other bacterial STIs and a rising incidence of viral STIs. However, a resurgence of syphilis has been observed and reported. The aim of our study was to find out the trends of syphilis among blood donors in Bastar region. Materials and Methods: This study was carried in a blood bank, attached to the Government Medical College in Bastar region, Chhattisgarh. This was a retrospective study. A total of 12,680 blood donors were screened for syphilis during 3 years (from 2011 to 2013) by Syphichik Rapid Dipstick test (Modified Treponema pallidum hemagglutination assay) and data was analyzed with respect to sero-reactive cases. Results: Out of 12,680 blood donors screened for transfusion transmitted infections, 134 donors were sero-reactive for syphilis, five donors had co-infections syphilis and hepatitis B infections, while four donors had syphilis with human immunodeficiency virus (HIV) infections. Prevalence of syphilis was more in replacement donors than voluntary donors and was in raising trend. Conclusions: Prevalence of syphilis among blood donors was in raising trends in this region and was more in replacement donors. The most common co-infections in our study were syphilis with hepatitis B infection, followed by syphilis with HIV infection. Increasing prevalence of syphilis among the donors underscores the concern about growing infection of this disease in the community as these blood donors represent the highly selective community. Proper counseling prior to blood donation, brief medical examination of blood donors and awareness about syphilis among blood donors may increase the safety of blood as well as community.

Strong evidence supports the use of noninvasive ventilation (NIV) in acute respiratory failure (ARF) to prevent endotracheal intubation (ETI) in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary edema, and immunocompromised patients. However, weaker evidence supports NIV used in acute respiratory distress syndrome (ARDS) and ARF due to community-acquired pneumonia (CAP) in immunocompetent patients owing to high rates of treatment failure. In all patients, NIV should be applied under close monitoring for signs of treatment failure and, in such case, ETI should be promptly available. A trained team, at an appropriate location, with careful patient selection and optimal choice of devices can optimize NIV outcome. In this short review we examine past and more recent literature regarding the use of NIV in ARF due to CAP, discussing the application of both continuous positive airway pressure (CPAP) and pressure support ventilation (PSV).

Ophthalmic infections of fungal origin, namely mycotic keratitis, mycoticendophthalmitis, etc., are commonly encountered in the tropical and sub-tropical countries including India. Mycotic keratitis, in particular, presents an important ophthalmic problem causing visual disability due to its protracted course and unfavorable responses. Determination of various host and environmental factors that put an individual at risk for development of fungal infections in the eye may reduce the time to their diagnosis. Even though Aspergillus and Fusarium are the most common species causing keratitis, pigmented dematiaceous fungi remain an important cause of mycotic keratitis. Majority of fungal keratitis responds to medical therapy if diagnosed on time and treatment started immediately. Failure of medical therapy may be due to infection of the cornea by certain pathogens or late presentation, which requires surgical treatment in conjunction with anti-fungal therapy post-operative. We, therefore, searched for literatures using the keywords "pigmented fungi, pheohyphomycosis, keratitis, ophthalmology" through GoogleScholar and reviewed the microbiology of pheohyphomycosis of the eye and its treatment in the light of improved culture and diagnostic methods.

Community-acquired pneumonia (CAP) remains an important cause of morbidity and mortality in developed countries. The disease is one of the top 10 causes of death and up to the present time, standard aggressive medical care has not resulted in a decrease in mortality. Knowledge of risk factors for CAP is essential to the design of preventive measures to reduce its incidence. Preventive strategies promoting effective vaccines or identifying and acting on modifiable risk factors are of paramount importance in reducing CAP-related death. Most studies have been performed in patients referred for inpatient care or in CAP cases in which a specific pathogen has been identified, but data from population-based studies are scarcer. We present a review of the main risk factors for CAP in adults, classified in the following categories: (a) Comorbidities and their treatments, (b) demographic and socioeconomic factors, (c) lifestyle factors and (d) environmental factors. We conclude with some brief recommendations on preventive measures and vaccination.