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.

Background: Breast cancer is the most prevalent cancer among women worldwide and it is found to be increasing. Breast cancer survivors are threatened with various problems due to disease itself or its treatment and might exist for a long period even after treatment. The existing knowledge on experiences and needs among breast cancer survivors in India is very limited. The present study aimed to explore the experiences and needs of breast cancer survivors. Methods: In the present study qualitative study design was used and 17 breast cancer survivors, post six months of completed cancer treatment were selected using purposive sampling technique. In-depth interviews were conducted, the data was transcribed and translated and codes and theme were developed. Results: The study explored the needs and experiences of breast cancer survivors. The experiences of breast cancer survivors were as follows; awareness, psychological expressions, spirituality and misconceptions, economic burden, confinement, body image and bashfulness, maintaining secrecy, family support and physical burden. The needs of breast cancer survivors were identified as financial, informational, breast reconstruction surgery, help in household activities, family support, counseling and emotional support. Conclusion: Recognizing the experiences and needs of the breast cancer survivors by the family members, health care workers, community members and policy makers after the end of treatment is important to facilitate optimal delivery of health care at the community settings to improve the quality of life of breast cancer survivors.

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Vitamin D deficiency (VDD) partly explains geographical differences in COVID-19 susceptibility, severity, and mortality. VDD among African-Americans, diabetics, hypertensive, and aged populations possibly explain the higher death rate, aggravated by cocooning. Vitamin D is pleiotropic, mediating bone metabolism, calcium homeostasis, and immune functions, whereas VDD is associated with inflammatory reactions and immune dysfunction, predisposing individuals to severe infections. Vitamin D modulates innate and adaptive immunity via the expression of genes that code antimicrobial peptides (AMPs). And the expression of cluster of differentiation (CD)14, the co-receptor for epidermal toll-like receptor (TLR)4. AMPs stimulate TLR2 in macrophages, increasing the conversion of vitamin D into its active form by cytochrome P450 27B1. Antiviral properties of vitamin D-induced AMPs can shift the polarization of the adaptive immune response from helper T cells (Th)1 to the more regulatory Th2 responses that suppress immune over-reactivity by preventing cytokine storm, which is already demonstrated during the Spanish flu episode. Vitamin D induces antiviral effects by both direct and indirect mechanisms via AMPs, immunomodulation, the interplay between major cellular and viral elements, induction of autophagy and apoptosis, variation of genetic and epigenetic factors. The crosstalk between vitamin D and intracellular signaling pathways may operate as a primary regulatory action on viral gene transcription. VDD may increase the likelihood of infection with enveloped viruses, including retrovirus, hepatitis, and dengue. Global data correlates severe VDD with COVID-19 associated coagulopathy, disrupted immune response and mortality, reduced platelet count, and prolonged prothrombin time, suggesting benefits from supplementation. KEY TEACHING POINTS Vitamin D induces antiviral effects by direct and indirect mechanisms via AMPs, immunomodulation, induction of autophagy, etc. Epidemiology of VDD partly explains geographical differences in COVID-19 susceptibility, severity, and mortality. Global data correlates severe VDD with COVID-19 associated coagulopathy, disrupted immune response and mortality, reduced platelet count, and prolonged prothrombin time, together suggesting benefits from supplementation. Many clinical trials are underway globally to delineate the role of vitamin D in both prevention and treatment of COVID-19.

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