Background: Every time an antibiotic is used, whether appropriately or not, the probability of the development and spread of antibiotic resistant bacteria is increased. Thus, multidrug resistant bacteria particularly ESBL (Extended spectrum β­lactamase), Amp C and carbapenemases producing gram negative bacilli have emerged as a major health problem all over the world. Considering new treatment options as a carbapenems sparing and resistance prevention modality, this study was aimed to know the in vitro susceptibility pattern of Cefepime/Tazobactam (CPM/TZ) in comparison to other β-Lactam/ β-Lactamase inhibitors (BL/BLI) and carbapenems against GNB.Methods: A prospective study was conducted on all clinical samples received for a period of about 1 year. Identification and susceptibility of all isolates was done by Vitek 2 Compact system. Susceptibility of CPM/ TZ was done by disc diffusion method on the basis of CLSI guidelines. Both fermenters (E. coli and Klebsiella pneumoniae) and non-fermenters (Acintobacter baumanii and Pseudomonas aeruginosa) were included in the study.Results: Out of 550 GNB isolates the most common was E. coli (61.8%), Acintobacter baumanii (16%), Klebsiella pneumoniae (14.9%) and Pseudomonas aeruginosa (7.3%). Cefepime/tazobactam had a much higher susceptibility of 68% compared to cefepime (28%). Among the BL/BLI combinations tested cefepime/tazobactam (68%) showed the maximum percentage of susceptibility followed by cefoperazone/sulbactam (61.5%) and piperacillin/tazobactam (57.6%). Amongst all GNB isolates cefepime/tazobactam (68%) sensitivity was very much comparable to imipenem (71.8%) and meropenem (69.6%).Conclusions: CPM/TZ exhibited the best in vitro activity in comparison to the other BL/BLI. This new combination of cefepime/tazobactam appears to be a promising alternative therapeutic option to carbapenems. Clinical studies are needed to confirm this in vitro study result.

Tuberculosis has re-emerged as a serious health concern as a result of AIDS epidemic, immigration from areas where the disease is endemic and multi drug resistance, with 8.8 million patients affected worldwide in 2010. Infections with mycobacterium tuberculosis (MTb) are globally prevalent in many countries, yet descriptions of placental pathology in tuberculous patients are few. Moreover, the diagnosis of tuberculosis in pregnant patients can be missed or delayed owing to the insidious onset and variability of clinical presentation, often overlapping with non-specific symptoms common in pregnancy such as loss of appetite, malaise and lethargy. The exact incidence of tuberculosis in pregnancy is not readily available in many countries due to confounding factors. However, it is expected that the incidence of tuberculosis in pregnant women is high as in general population, with higher incidence in developing countries. Placental tuberculosis shows predominantly neutrophilic and histiocytic response in the form of villitis and intervillitis which is due to the innate immune response. This innate response contributes more to tissue injury than protection as proved in our case, where it led to intrauterine death of the fetus. We, hereby report a case of placental tuberculosis, diagnosed on histopathological examination of placenta showing caseating epithelioid cell granulomas with langhan’s giant cells and Acid Fast Bacilli on Zeihl Neilson stain.

No abstract

No abstract

Multiple malignancies in the same patient account for 2% to 17% of all cancers. However, multiple synchronous primary tumours in the same patient are extremely rare. Most synchronous primary tumors involve the genitourinary and gastrointestinal tract, followed by both breast and genitourinary tract, and breast and gastrointestinal tract. Among gynaecological malignancies, synchronous primary carcinomas of the endometrium and ovary are the commonest. Synchronous primary neoplasm involving kidney and ovaries are extremely rare, with only few case reports in the literature; however, there are no reported cases in the Indian literature. We hereby report a case of 60 year old woman who underwent radical nephrectomy for renal cancer and primary cytoreductive surgery for her ovarian cancer. In this report we present the first case in the Indian literature of synchronous primary cancers in right kidney and bilateral ovaries. Based on the combination of factors (diagnosis, treatment and demographics), it is expected that in the course of the coming years, the prevalence of patients with multiple primaries will increase. Careful attention should be paid to the differential diagnosis between double primary and metastatic tumours, based on the pathologic, radiological and clinical characteristics.