Background:Diabetic foot infections (DFIs) are major public health problems and knowledge of microbes that cause infections are helpful to determine proper antibiotic therapy.Aims:The aim was to investigate the antimicrobial susceptibility pattern of microbes in DFIs.Subjects and Methods:A cross-sectional study was conducted for a period of 6 months at the Department of General Surgery, KMC hospital, Manipal University, Manipal, India. During this period, 108 patients having DFIs admitted in the general surgery wards were tracked from the hospital data management system. These patients’ pus samples were examined as Gram-stained smear and cultured aerobically on blood agar and MacConkey agar plates. Antimicrobial susceptibility test was performed by disc diffusion techniques according to Clinical and Laboratory Standards Institute guidelines.Results:Of the 108 specimens of the diabetic foot lesions, culture showed polymicrobial growth in 44.4% (48/108). Prevalence of Gram-negative organisms (56%, 84/150) was found to be more than Gram-positive organisms (44%, 66/150). However, Staphylococcus aureus was the most frequent pathogen (28%, 42/150). All Gram-positive aerobes were sensitive to doxycycline. All Gram-negative isolates, including extended spectrum beta lactamase producing strains of Proteus mirabilis and Klebsiella oxytoca except Acinetobacter were highly sensitive to amikacin, cefoperazone/sulbactam, and meropenem. Acinetobacter was completely resistant to all the common antibiotics tested.Conclusion:Prevalence showed Gram-negative bacteria was slightly more than Gram-positive bacteria in diabetic foot ulcers. This study recommends doxycycline should be empirical treatment of choice for Gram-positive isolates and amikacin, cefoperazone/sulbactam, and meropenem should be considered for most of the Gram-negatives aerobes.

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Paraquat is a bipyridilium herbicide used widely in our country and is a highly toxic compound. A 16-year-old female patient was admitted to the emergency department of our tertiary care hospital in South India with the history of alleged consumption of paraquat poison. Since there is dearth of high quality evidence- based treatment for this poisoning, different treatment modalities have been tried to manage patient's condition. In this case, none of the strategies could work well. Most of the patients reported with paraquat intoxication are from agricultural background; usually such patients cannot afford the treatment expenses. This paper presents a fatal case of acute poisoning with paraquat who succumbed to acute respiratory distress syndrome (ARDS).

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Paraquat is an effective herbicide widely used in India, but is highly toxic on human exposure. Cyclophosphamide is used as pulse therapy in combination with methylprednisolone for paraquat poisoning management. Neutropenia and thrombocytopenia are the main side effects which may occur with cyclophosphamide in cancer treatment due to bone marrow suppression. Hereby we report a rare case of cyclophosphamideinduced fatal cytopenia in a patient with paraquat poisoning. This is a case of 24 y old male who came to the emergency department of our hospital with a history of alleged consumption of 50 ml of paraquat liquid. On admission, he complained of pain and burning sensation in the throat and retrosternal region. Different treatment modalities, namely, pulse therapy with cyclophosphamide and methylprednisolone; and hemoperfusion were used to manage patient's condition. Within few days, the patient developed severe neutropenia and thrombocytopenia. Despite several blood transfusions, the patient expired due to fatal manifestations of cytopenia.

BACKGROUND: Hospitalised TB patients are at heightened risk for developing drug–drug interactions (DDIs) due to overlapping CYP450 enzyme and/or drug transporter biotransformation of anti-TB drugs and co-medications given for treating TB-associated comorbidities. We aimed to compare the occurrence, characterisation and determinants of database identified potential DDIs (pDDIs) associated with first-line anti-TB drugs and other co-medications using a subscription and free access drug information database.METHOD: This was a single-centre retrospective study to assess pDDIs between first-line anti-TB drugs and other medications for comorbidities among hospitalised TB patients using IBM Micromedex® and Drugs.com.RESULTS: On multivariate regression analysis, hospitalised TB patients with comorbidities such as diabetes mellitus, HIV infection and hypertension, longer hospitalisation, and patients administered with more than seven drugs during their hospital stay were associated with increased risk for the occurrence of pDDIs. Significant discrepancies were observed in the detection and severity of pDDIs between IBM Micromedex and Drugs.com.CONCLUSION: We recommend using free access drug information database to a subscription drug information database in drug interaction screening protocols in clinics for enhanced identification of pDDIs and reducing monetary burden in resource-limited settings.

Objectives To determine the rate of coinfections and its subsequent impact on hospitalization and mortality rate in Indian COVID-19 patients. Method Systematic literature search was performed on PubMed, Cochrane, WHO-COVID-19 database, and Google Scholar. The studies were retrieved and included based on JBI’s CoCoPop framework. Meta-analysis was not performed due to limited number of studies and high heterogeneity. Hence, descriptive statistics was summarized based on the retrieved coinfections data. The protocol was registered with PROSPERO – CRD42021275644. Results Eight studies included 2418 patients. The prevalence of coinfections ranged from 4%-46%. Pathogen-specific data showed the highest prevalence of bacterial (57.3%) coinfections, followed by parasitic (21.1.%), viral (14.6%), and fungal coinfection (6.9%). About 60–80% of the patients with coinfections required ICU admissions with an average length of stay of 13.67 ± 3.51 days. The mortality rate of COVID-19 patients with coinfections ranged from 9%-65%. Conclusion The prevalence of bacterial coinfections was highest among COVID-19 patients, consistent with previous literature. A causal relationship between coinfections and mortality rate in COVID-19 patients remained unexplored. This brings up the need for comprehensive data recording practices and meticulous reporting. Further, large-scale epidemiologic studies are needed to determine the nationwide burden of coinfections in the COVID-19 pandemic.

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