Infectious Disorders - Drug Targets (Formerly Current Drug Targets - Infectious Disorders) - Volume 15, Issue 3, 2015

Objectives: Polyphenols constitute the major component in green tea, which represent a cluster known as catechins. The presence of polyphenols, especially the amino acid theanine and catechins with its antioxidant properties in green tea make them ideal for medicinal- dental applications. The objective of the paper is to delineate the role of green tea polyphenols in periodontal disease. Methods: The Pub med data base was searched for human clinical studies, reviews pertinent to application of green tea polyphenols in periodontal health dating from Sep 1980- Sep 2014. Results: The retrieved inference from the epidemiological surveys, in vitro studies and overviews of polyphenols, postulate green tea as potential natural antioxidant. Green tea mouthwashes possess limitations, which make them ineffective during the chronic stages of periodontitis. Human studies reveal that the prognosis of periodontal disease is better when the green tea catechins are used via local drug delivery. Conclusion: The maintenance of periodontal health could be enhanced by emphasizing the habit of drinking green tea in periodontitis patients. The future scope of the research demands the analysis of polyphenols at molecular level to have a better understanding of its overwhelming applications.

Tributylstannic[3-(3,5 -dimethylphenylamido)propionate] is synthesized and characterized by elemental analysis, FT-IR, multinuclear NMR (1H, 13C and 119Sn) and mass spectrometry. The organic anion was found to act as monodentate O-bound ligand in solution. The compound was screened for the anti-HCV potency by the Gaussia luciferase Assay using infected Huh 7.5 cells (human hepatocellular cell) and is found active against HCV with logIC50 1.2nM in the cell-based assay. Cationic surfactant cetyl N,N,N-trimethylammoniumbromide (CTAB) was used to study the interactions of the organotin(IV) complex with positively charged micelles of the surfactant acting as a model cell membrane. The thermodynamics parameters of complex- CTAB interaction concluded that the complex is located in the palisade layer of CTAB micelles. The increase in absorbance of visible spectra of the compound confirmed its solubilization into micelles. The two carbonyl oxygen’s were found to be binding sites of the complex with CTAB.

Acute obstructive pyelonephritis (AOP) is a urological life-threatening inflammatory condition that initially requires immediate urinary drainage and simultaneous prescribing of highly effective targeted antibacterial treatment. The empirical antibacterial therapy is always prescribed before urine culture and susceptibility testing are done. Percutaneous nephrostomy (PNS) and ureteral stenting (US) are the two options for urinary drainage in obstructed kidneys, while fluoroquinolones and 3rd generation cephalosporins are the main groups of antibacterial drugs that are recommended and are available for empirical AOP therapy. In our study we aimed to compare efficacy of fluoroquinolone ciprofloxacin vs 3rd generation cephalosporin ceftazidime in empirical antibacterial treatment of patients with acute obstructive pyelonephritis. We also tried to analyze the impact of urinary drainage option on cure rates. 241 AOP patients were randomized into two groups: Group 1, n=124 pts in whom percutaneous nephrostomy was performed urinary drainage and Group 2, n=117 pts, in whom ureteral stenting was made. Then each abovementioned group was also randomized into equal two subgroups (ciprofloxacin vs ceftazidime) depending on the empiric antibacterial treatment which was chosen. Our results revealed that cure rates in patients treated by ceftazidime were higher than those who were treated by ciprofloxacin. At late follow-up, the clinical cure rate in PNS group treated by ceftazidime was 95.2% vs 83.6% in ciprofloxacin arm, while the microbiological cure rates were 92.9% vs 80.0% correspondingly (p<0.05). At late follow-up, the clinical cure rate in US group treated by ceftazidime was 86.4% vs 74.1% in ciprofloxacin arm while the microbiological cure rates were 82.4% vs 69.4% correspondingly (p<0.05). We also concluded that percutaneous nephrostomy ensures a better clinical cure than ureteral stenting at early and late follow-ups regardless of the drug regimes which were chosen. Thus, in our opinion, percutaneous nephrostomy combined with ceftazidime treatment can be considered as the most effective option in patients with acute obstructive pyelonephritis.

Background: Bloodstream infections (BSI) caused by various Candida spp. are a significant cause of morbidity and mortality in hospitalized patients. An increasing proportion of device- related infections, particularly those involving the bloodstream and urinary tract, are being caused by Candida spp. Aims and objectives: This study was conducted to evaluate the different species of Candida causing blood stream infections and their antifungal susceptibility. Material and methods: The present study was conducted on 12464 blood samples received for culture, the samples were incubated at 37ºC for overnight and inoculated on culture plate next day. The growth on culture plates was identified by standard microbiological techniques and their antifungal susceptibility was put up as per Centre for Laboratory Standard Institute guidelines. Results: Out of 12464 blood samples, isolation rate of Candida spp was 7.25%, which was higher in paediatric age group patients (89%) as compared to adults (11%). BSIs due to Candida spp. was significantly more common among ICUs (72%) than non-ICU settings (28%). C. tropicalis was the commonest (43%) species isolated followed by C. albicans (41%), C. krusei (9%) and C. parapsilosis (7%). All strains were 100% sensitive to Amphotericin B. Conclusion: There is a changing trend of increased isolation of non albicans Candida spp. than Candida albicans. It was common in ICUs settings and in paediatric age group. All isolates were found 100% sensitive to Amphotericin-B, C.krusei was 100% resistant to fluconazole followed by C. tropicalis 32.6% and C. parapsilosis 28.58%.

Adequate adherence to anti-retroviral therapy is required to achieve viral suppression and desirable treatment outcomes among HIV patients. The aim of this study was to examine the associations between adherence and severity of substance use as well as adherence and severity of depressive symptoms among Iranian HIV patients. In a prospective study, HIV patients with current substance use were assessed for adherence level via self report and pill count methods, severity of depressive symptoms (Beck Depression Inventory- II) and substance use (Addiction Severity Index) during a three months follow up after initiating antiretroviral therapy. The adherence level, severity of depressive symptoms and substance use were assessed one month, two months and three months after initiation of anti-retroviral therapy. Addiction Severity Index (ASI) composite scores were calculated for each domain and the associations between ASI domains and adherence as well as severity of depressive symptoms and adherence were assessed. Twenty six HIV patients with current substance use disorder completed the study. At the end of the first month, adherence to therapy via pill count and self-report were 80%±31.9% and 85.12%±32%, respectively. At the end of the second month, adherence to therapy via pill count and self report were 87%±32% and 93.94%±23% respectively. At the end of the third month, the measured adherence via pill count and self report were 85%±33.7% and 90.1%±25.7% respectively. Adherence was higher among married patients and those who used reminder systems. Composite scores of the medical status and psychiatric status were related to higher adherence after first month. Substance use was inversely associated with adherence at the second follow up (r=-0.4, p=0.04). Also, severity of depressive symptoms was not related to adherence level. The repeated measurement analysis showed a significant decrease in psychiatric status domain of the ASI composite score after three months of initiating therapy (p=0.02). Preventive measures should aim treatment of substance use among HIV patients in order to increase adherence level. Also, conducting psychological evaluations is necessary considering the high prevalence of depression among Iranian HIV patients.

Background: Acinetobacter species are ubiquitous in the environment and are important causative agent for nososcomial infection especially in immunocompromised patients. Multi drug resistant Acinetobacter lwoffii are emerging as a pathogen in neoanatal sepsis. Aims and Objective: This study was aimed to evaluate the clinical and antibiotic profile of Acinetobacter lwoffii. Material and Methods: This study was done on blood samples from neonates admitted to neonatal intensive care unit during a period of one year from January to December 2012, who developed Acinetobacter infection. The diagnosis of isolates and antibiotic susceptibility testing was done by both conventional as well as by automated system. Results: Out of total 13,133 blood samples received for culture, 1418(10.8%) were from NICU. Ninety (6.3%) isolates were found to be positive for the growth of Acinetobacter species. Of these isolates 31.11% were found to be Acinetobacter lwoffii, 68.9% were Acinetobacter baumannii calcaetius complex. Acinetobacter lwoffii isolates were most commonly sensitive to imepenem 16(57%), cotrimoxazole 9(32%), ciprofloxacin 6(21%) followed by amoxyclavulanic acid 2(7%) and cefuroxime 1(3.5%). Conclusion: Multi drug resistant Acinetobacter lwoffii infection is increasing particularly in premature and very low-birth weight neonates. Judicious and timely antibiotic use in NICUs are one of the important key in controlling multi-drug resistant Acinetobacter infection and improving clinical outcome.

Background: Beta Thalassemia is inherited anemia characterized by absent or reduced synthesis of β-globin chains of hemoglobin, caused by β-globin gene mutations resulting in chronic hemolytic anemia that requires ‘repeated blood transfusion with resulting iron overload’. Silymarin has iron chelating activity in thalassemic patients with iron overload. Aim of the work: was to study the therapeutic value of combined therapy of Deferiprone and silymarin as iron chelators in Egyptian children with beta thalassemia with iron overload’. Patients and Methods: ‘This study was conducted on 80 beta thalassemic children with their serum ferritin more than 1000 ng/ml who were divided into two groups’. Group I included 40 patients who were treated with oral Deferiprone and silymarin for 9 months. Group II included 40 patients who were treated with oral Deferiprone and placebo for 9 months. Results: ‘There were no significant differences in serum ferritin, iron and TIBC between group I and group II before the study but after regular chelation therapy, serum ferritin and iron were significantly lower in group I than group II. No statistically significant differences in serum creatinine, blood urea, ALT, AST and bilirubin levels between Group I and Group II before and after chelation therapy were observed’. Conclusion: Deferiprone in combination with silymarin are better iron chelators than Deferiprone and placebo. Recommendations: ‘Extensive multicenter studies in large number of patients with longer follow up period and more advanced methods of assessment of iron status to clarify the exact role of silymarin in reduction of iron over load in thalassemic children’.

Objectives and Aims: Escherchia coli isolated, from urine samples were studied for their antibiotic susceptibility patterns, with special reference to the new antimicrobial compound fosfomycin and their correlation with various virulence factors. Material and Methods: The mid stream urine samples received in the department were processed and identification was done by using the standard culture and identification techniques. The antibiotic susceptibility testing was done by modified Kirby-Bauer disk diffusion and the disk diffusion method was used to confirm the ESBL, AmpC, MBL production by the UPEC. Various virulence factors like hemolysin, haemagglutinaton, gelatinase, siderophore production, biofilm formation, serum resistance and hydrophobicity were detected. Results: Fosfomycin was found to be most effective agent (100%) against uropathogenic E.coli followed by netilmicin (89.5%). The least effective agents were ampiciilin and cotrimoxazole. Twenty nine percent (29%) isolates were found to be multi drug resistant (MDR). Conclusions: The testing of the newer therapeutic agents like fosfomycin will add on to therapeutics for UTI’s.

We report a case of Coccidioidomycosis of the cranium that presented as a cystlike structure with adjoining bone destruction in a 40-year-old patient with underlying rheumatoid arthritis that was treated with a combination of lipid amphotericin B and longterm fluconazole. We also discuss the common risk factors and presentations of this unusual extra-pulmonary form of Coccidioidomycosis.