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.

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.

The present study is the first report on the antifungal activity of various extracts of P. granatum against fluconazole resistant Candida isolates. Ethanol extract of P. granatum peel showed excellent anticandidal activity against fluconazole resistant Candida spp. Hence, it can be explored further to identify a potential drug candidate.

Background: The objective of our study is to determine the prevalence of vulvovaginal candidiasis and influence of maternal age, parity or trimester on its occurrence among pregnant women, attending the antenatal clinic in our teaching hospital. It helps us to understand the magnitude of the problem in our region and to implement the necessary treatment modalities to reduce the preterm births attributed to vaginal candidiasis.Methods: It was a hospital based prospective study over a period of six months. High vaginal swabs were collected from the pregnant patients after getting consent and sent for culture. Candida positive cases were noted and results were analysed.Results: A total of 200 high vaginal swabs were collected and reported in our study. Among them 108 swabs were positive for Candida growth (54%) and 92 swabs were negative for growth (46%). Culture positive patients clinical details were analyzed and statistical significance was noted (based on age group, parity and trimester).Conclusions: Our study concluded that candidiasis is more prevalent in pregnant women but there was no statistical significance in occurrence of vaginal candidiasis among various age groups, parity or trimester. Hence it is better to screen all the patients in I/ early II trimester in order to find out and treat positive cases early to prevent preterm births attributed to vaginal candidiasis.

Background: Chitosan (deacetylated chitin) and its derivatives, which are known to possess pharmaceutical and biomedical properties, have gained considerable attention in the biomedical field. The nontoxic, biocompatible, and biodegradable nature of chitosan makes it possible to use it for therapeutic purpose. It exhibits antibacterial effect on both Gram-positive and Gram-negative cell wall types of bacteria and so-called "antimicrobial polysaccharide." Aims and Objective: To study the antibacterial activities of native chitosan and its derivatives against three Gram-negative bacteria (Escherichia coli, Klebsiella spp., and Proteus spp.). Materials and Methods: Bactericidal activity of native chitosan, chitosan hydrolysates obtained by hydrogen peroxide (H2O2) and lysozyme degradation, chitosan-zinc (Zn) complex, and glucosamine hydrochloride was tested against ATCC strains of E. coli, Klebsiella spp., and Proteus spp. and clinical isolates of E. coli, Klebsiella spp., and Proteus spp. procured from a clinical diagnostic laboratory. Statistical analysis was done using SPSS software, version 20. Results: Both chitosan and its derivatives markedly inhibited the growth of most bacteria tested; however, the effects differed with regard to the type of the bacterium. The minimum inhibitory concentration for E. coli ATCC strain was 50 µg and its bactericidal activity was dose dependent. Chitosan hydrolysates also exhibited an inhibitory effect, although differences were seen among strains. Degrades from H2O2 had higher activity than native chitosan. Lysozyme-degraded chitosan had less activity compared to hydrolysates obtained from H2O2 hydrolysis. Chitosan-Zn complex also showed wide spectrum of antimicrobial activities against all the microorganisms tested and the effects were found to increase with increasing chelate ratios. No antibacterial effect was observed in the case of monomer glucosamine hydrochloride, showing that only oligomers have bactericidal effect. Conclusion: The antibacterial potential of chitosan and its derivatives is considerable and its prospect to be developed as a chemotherapeutic agent is high.

There are many studies on the laparoscopic cholecystectomy in rural hospitals. It is important to understand whether the advantages of the laparoscopic cholecystectomy are there in the rural hospital set up. The present systematic review of literature aims to find the various outcomes of laparoscopic cholecystectomy in rural hospitals. The study was conducted based on PRISMA guidelines for systematic reviews. The MEDLINE and EMBASE database were used the retrieve the articles. A detailed descriptive analysis was on the various outcomes of open and laparoscopic cholecystectomy. The present systematic review has identified that the laparoscopic cholecystectomy in rural hospitals is most preferred as that of urban setting. It not only provides less hospital stay, but also provides economical option for rural patients. However, there are some limitations in many rural settings like lack of instrumental facility and trained surgeon. The outcomes of the laparoscopic cholecystectomy in some rural hospitals are comparatively same as that of urban settings.

The scenario of Tragedy of Commons was narrated by English Mathematician and Economist William Forster Lloyd, in 1833. This research paper relates household waste management in Mumbai to the Tragedy of Commons. In 2016, the Ministry of Environment revised Solid Waste Management Rules, whereby it mandated segregation of waste at source to turn waste into wealth by 'recovery, reuse and recycle'. These new rules make waste management the responsibility of the waste generator so that it can be handled in an efficient, decentralized manner without overburdening the limited public resources and infrastructure. In this paper, an investigation has been done of how the scenario of Tragedy of Commons is applicable despite all these rules, and how people end up 'fouling their own nest'. This paper proposes improved ways for sustainable household waste management. The major discussion of this paper is on the environmental, economic, and health benefits of composting organic waste and recycling plastic waste from the HW.