Melanoma is a most dangerous and deadly type of skin cancer, and considered intrinsically resistant to both radiotherapy and chemotherapy. It has become a major public health concern as the incidence of melanoma has been rising steadily over recent decades with a 5-year survival remaining less than 5%. Detection of the disease in early stage may be curable, but late stage metastatic disease that has spread to other organs has an extremely poor prognosis with a median survival of less than 10 months. Since metastatic melanoma is unresponsive to therapy that is currently available, research is now focused on different treatment strategies such as combinations of surgery, chemotherapy and radiotherapy. The molecular basis of resistance to chemotherapy seen in melanoma is multifactorial; defective drug transport system, altered apoptotic pathway, deregulation of apoptosis and/or changes in enzymatic systems that mediate cellular metabolic machinery. Understanding of alterations in molecular processes involved in drug resistance may help in developing new therapeutic approaches to treatment of malignant melanoma.
Background/Aim:Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of nosocomial infections worldwide. The aim of this study was to determine the prevalence of MRSA and their antimicrobial susceptibility pattern in our hospital located in Mangalore, India.Materials and Methods:The bacterial isolates from various clinical specimens of patients admitted in our hospital were cultured as per standard protocol and all isolates of Staphylococcus aureus obtained were included in the study. The isolates were identified by standard methods like catalase test, slide and tube coagulase tests, and growth on Mannitol salt agar (HiMedia Lab, Mumbai). The antimicrobial susceptibility testing was performed by Kirby–Bauer disc diffusion method. The D-test for inducible clindamycin resistance was performed. The isolates were tested for methicillin resistance by using oxacillin disc by disc diffusion method and confirmed by agar screen test (oxacillin 6 μgm/ml). The results were interpreted according to CLSI criteria.Results:During a period of one year, a total of 237 isolates of S. aureus were studied and 69 (29.1%) were found to be methicillin-resistant. MRSA isolates showed greater resistance to multiple drugs than methicillin sensitive Staphylococcus aureus MSSA isolates. Inducible clindamycin resistance was 18.8% in MRSA as against 3.5% in MSSA. About 40–50% of MRSA were resistant to erythromycin, gentamicin, and chloramphenicol, while less than 30% were resistant to ciprofloxacin and amikacin. However, all strains were sensitive to vancomycin.Conclusion:The regular surveillance of hospital-acquired infections of MRSA may be helpful in formulating and monitoring the antibiotic policy. This may also help in preserving antibiotics like vancomycin, only for life-threatening staphylococcal diseases.
The World Health Organization (WHO) has articulated a priority pathogens list (PPL) to provide strategic direction to research and develop new antimicrobials. Antimicrobial resistance (AMR) patterns of WHO PPL in a tertiary health care facility in Southern India were explored to understand the local priority pathogens. Culture reports of laboratory specimens collected between 1st January 2014 and 31st October 2019 from paediatric patients were extracted. The antimicrobial susceptibility patterns for selected antimicrobials on the WHO PPL were analysed and reported. Of 12,256 culture specimens screened, 2335 (19%) showed culture positivity, of which 1556 (66.6%) were organisms from the WHO-PPL. E. coli was the most common organism isolated (37%), followed by Staphylococcus aureus (16%). Total of 72% of E. coli were extended-spectrum beta-lactamases (ESBL) producers, 55% of Enterobacteriaceae were resistant to 3rd generation cephalosporins due to ESBL, and 53% of Staph. aureus were Methicillin-resistant. The analysis showed AMR trends and prevalence patterns in the study setting and the WHO-PPL document are not fully comparable. This kind of local priority difference needs to be recognised in local policies and practices.
Background and Objectives: Urinary Tract Infections (UTI) are the second most common infections after the respiratory tract infections and constitute a great proportion of prescription of antibiotics. The present study was designed to determine the etiology of uropathogens and their susceptibility pattern in outpatients and inpatients of our hospital so as to arrive at an empirical treatment for patients with UTI. Materials and Methods: A total of 924 urine samples were obtained from inpatients and outpatients with a clinical diagnosis of UTI. The samples were cultured and antibiotic susceptibility of isolates determined by disc diffusion method. Results: Of 924 urine samples processed (828 from inpatients and 96 from outpatients), 262 (28.35%) yielded bacterial isolates. About 216 (26.08%) samples from inpatients and 46 (47.9%) from outpatients showed significant bacteriuria. Escherichia coli predominated in both groups, followed by Klebsiella spp., Pseudomonas spp., Acinetobacter spp., and Enterobacter spp., which were isolated from only the inpatient samples. Sensitivity to nitrofurantoin varied from 73% to 94% and fluoroquinolone resistance was documented as 11%-80%. Resistance to amikacin, ceftazidime, and ceftriaxone was less than 25%. Imipenem resistance was found in <5% of the bacterial isolates. Conclusion: E. coli and Klebsiella spp. are the major uropathogens. Resistant strains are prevalent in the community, as evident by the fact that there is not much difference in resistance patterns of isolates from inpatients and outpatients. Taking into account the resistant pattern, nitrofurantoin represents the option of first choice for empirical therapy of uncomplicated UTI. Optimized content for mobile and hand-held devicesHTML pages have been optimized of mobile and other hand-held devices (such as iPad, Kindle, iPod) for faster browsing speed. Click on [Mobile Full text] from Table of Contents page. This is simple HTML version for faster download on mobiles (if viewed on desktop, it will be automatically redirected to full HTML version)
Background:Children with adenoid hypertrophy have been shown to harbor pathogenic bacteria in the nasopharynx despite antibiotics. Removal of the adenoid is associated with a reduction in the bacterial count.Aims:The study was done to determine the bacteriology of the adenoid tissue in chronic adenotonsillitis and adenoid hypertrophy, and determine the antibiotic sensitivity of potential pathogens.Materials and Methods:This is a descriptive study conducted on 100 patients aged between three and twelve years who underwent adenotonsillectomy/adenoidectomy. After adenoidectomy, the specimen along with the swab taken from the surface of the adenoid was sent for microbiological examination. After 48 and 96 hours, the microbial growth was identified and the antibiotic-sensitivity pattern of the isolate was studied.Results:Aerobic organisms grew in 93% of the specimens and anaerobic organisms in 68%, whereas 7% had no growth. The surface was predominated by commensals and the pathogens were mainly found in the core. The predominant pathogens were Staphylococcus aureus, Streptococcus pneumoniae, and Enterococcus species. The organisms were resistant to penicillin but showed sensitivity to co-amoxiclav and ciprofloxacin. Co-amoxiclav and ciprofloxacin should be considered as the first line of medical treatment for adenotonsillar diseases.Conclusions:Infection is the main cause of adenoid hypertrophy. Amoxicillin with potassium clavulanate and ciprofloxacin should be considered as the drugs of choice for all adenotonsillar diseases. Early and prompt treatment of adenoid hypertrophy with appropriate antibiotics will avoid unnecessary exposure to repeated antimicrobial therapy, thereby maintaining the beneficial effects of the normal adenoid flora.
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