No abstract

Introduction: Candida species is the common form of opportunistic fungal infections, especially in immunosuppressed individuals. Fluconazole is the first-line therapy for candidiasis as it is affordable and readily available. However, the antifungal resistance pattern in high-risk patients is a major concern. Aim: The objective of the present study was to assess the anticandidal activity of curcumin-silver nanoparticles (C-Ag-NPs) against fluconazole-resistant Candida species isolated from HIV patients. Materials and Methods: Ten milliliters of 0.1 M silver nitrate (AgNO 3 ) and 3 ml curcumin solution was heated in a water bath for 1 h at 60°C. The formation of the Ag-NPs was determined by color change from light yellow to brownish. The solution was centrifuged at 9000 rpm for 15 min and was washed with ethanol and later lyophilized for 24 h to obtain the purified curcumin-Ag-NPs (C-Ag-NPs). A stock of 1 mg/ml of C-Ag-NPs was prepared in deionized water. The agar diffusion test and broth dilution tests were conducted to determine the anticandidal activity of C-Ag-NPs. Results: C-Ag-NPs showed a better antifungal activity compared to curcumin and AgNO 3 solution. Candida glabrata and Candida albicans were the most inhibited and Candida tropicalis was the least inhibited species. The mean zone diameter was 22.2 ± 0.8 mm, 20.1 ± 0.8 mm, and 16.4 ± 0.7 mm against C . glabrata , C . albicans and C . tropicalis respectively. Other Candida species under the study were also inhibited. Inhibitory activity was dose dependent and it increased with concentration. The minimum inhibitory concentration values for different Candida species ranged from 31.2 μg/ml to 250 μg/ml. Conclusion: This is the first report on the antifungal activity of C-Ag-NPs against fluconazole-resistant Candida isolates. C-Ag-NPs can be explored further to identify a potential drug candidate that can be used for the treatment of candidiasis due to fluconazole-resistant strains of Candida species.

Background and Purpose: Opportunistic fungal infections have been on a growingtrend since the last two decades. Among the opportunistic fungal agents, Candidaspecies, Cryptococcus neoformans, and Aspergillus fumigatus account for most of thelife-threatening infections in immunocompromised individuals. Regarding this, thepresent study aimed to investigate the molecular identification and antifungalsusceptibility pattern of Candida species isolated from HIV-infected patients.Materials and Methods: This study was conducted on 80 clinical samples collectedfrom HIV-infected patients with suspected candidiasis referring to Tagore MedicalCollege and Hospital, Rathinamangalam and Government Hospital of ThoracicMedicine, in Chennai, India, for 18 months (i.e., May 2016-December 2017). Phenotypicand molecular identification was accomplished using internal transcribed spacer region 1(ITS1) and ITS4 primers. The antifungal susceptibility pattern of the isolates against fourantifungal agents was also determined by both disk diffusion and broth dilution methods.Results: In the present study, the prevalence of candidiasis was obtained as 75% (n=60).Candida tropicalis was the predominant identified species. All the emerging species(i.e., Kodamaea ohmeri, Hanseniaspora opuntiae, and C. orthopsilosis) were identifiedthrough molecular identification since the phenotypic identification was inconclusive. Interms of the susceptibility pattern, 63.3% and 18.3% of the isolates were resistant tofluconazole and voriconazole, respectively. Candida albicans was also found to beresistant to amphotericin B.Conclusion: Molecular assay led to the identification of K. ohmeri, H. opuntiae, and C.orthopsilosis, which were multidrug-resistant. This study highlighted the need for theprompt and timely identification of clinical yeast isolates given the emergence of manyrare species and their capability of causing life-threatening infections and outbreaks. Inthe laboratories where molecular diagnostic methods are not available, alternativeservices of reference laboratories can be utilized as cost-effective measures. With regardto the growing prevalence of antifungal drug resistance, antifungal susceptibility testingshould be made mandatory for effective patient management.

Introduction:The risk of postoperative hemorrhage from oral surgical procedures has been a concern in the treatment of patients who are receiving long-term anticoagulation therapy. A study undertaken in our institution to address questions about the amount and severity of bleeding associated with minor outpatient oral surgery procedures by assessing bleeding in patients who did not alter their anticoagulant regimen.Subjects and Methods:Eighty-three patients receiving long-term anticoagulant therapy visited Department of Oral and Maxillofacial Surgery from May 2010 to October 2011 for extractions and minor oral surgical procedures. Each patient was required to undergo preoperative assessment of prothrombin time (PT) and measurement of the international normalized ratio. Fifty-six patients with preoperative PT values within the therapeutic range 3–4 were included in the study. The patients’ age ranged between 30 and 75 years. Application of surgispon was done following the procedure. Extraction of teeth performed with minimal trauma to the surrounding tissues, the socket margins sutured, and sutures removed after 5 days.Results:There was no significant incidence of prolonged or excessive hemorrhage and wound infection and the healing process was normal.

Background and Purpose:Azoles are preferred antifungal agents given their inexpensiveness, limited toxicity, and potentiality of oral administration. However, the extensive use of prophylactic azole therapy for chronic infections, especially in immunocompromised patients, has led to an increase in azole resistance, thereby rising health care costs. Fluconazole resistance is associated with poor clinical outcomes and the emergence of new infections. The present study aimed to investigate the mutations of ERG11 gene in fluconazole-resistant Candida albicans isolates.Materials and Methods:This study was conducted on 80 clinical samples collected from HIV-infected patients with suspected candidiasis in Tagore Medical College Hospital and Government Hospital of Thoracic Medicine, Chennai, India, for a period of 18 months (May 2016-December 2017). The antifungal susceptibility pattern was determined by agar diffusion and broth dilution techniques as per the Clinical and Laboratory Standards Institute guidelines. The ERG11 gene of the known fluconazole-resistant strains of C. albicans was amplified by polymerase chain reaction (PCR). In addition, the samples were subjected to sequencing and mutation analysis. Results:A total of 60 Candida species were isolated from HIV patients and were speciated using standard, conventional, and molecular methods. Candida albicans comprised 28.3% (n=17) of the Candida isolates, 59% (n=10) of which were resistant to fluconazole. Sequencing of the amplified product of ERG11 C. albicans gene isolates showed that they were highly mutated and included many nonsense mutations which were not reported earlier.Conclusion:The molecular characterization of ERG11 gene showed many missense and nonsense mutations. Such mutations, which were unique to the geographical area under investigation, could be concluded to account for the development of resistance to fluconazole.