Jorhat Medical College and Hospital

Background: Pyogenic infections refer to infections that leads to formation of pus. Selection of an effective antibiotic has a great role in reducing the morbidity and mortality among such infections. The awareness of the microbial profile causing pyogenic infections and their antibiogram is crucial for its management. Objective: To identify the bacteria, isolated from pus culture of suspected pyogenic infections, received in this hospital and to determine their antimicrobial susceptibility pattern. Materials and Methods: In this hospital-based retrospective study, a total of 1040 pus samples were subjected to culture according to standard microbiological procedure. Bacterial isolates were identified using conventional biochemical tests. Antibiotic susceptibility testing was done by Kirby-Bauer disk diffusion method and interpreted as per CLSI guideline. Results: Out of these 1040 samples, 59.4% were culture positive. Most of the positive samples were from Surgery Department (39.2%). The most common isolate was Staphylococcus aureus 39%. Overall, the Gram-positive bacteria demonstrated higher susceptibility to Doxycycline, Linezolid and Vancomycin. Whereas, the Gram-negative bacteria showed good susceptibility to Aztreonam, Carbapenems, and Piperacillin/ Tazobactam. Conclusion: The study provides an insight into the diverse bacterial etiology of pyogenic infections, and antibiogram revealed varying degree of resistance to some commonly used antibiotics.

Niemann-Pick C1-Like 1 (NPC1L1) is the primary intestinal transporter responsible for dietary cholesterol absorption and a validated therapeutic target for hypercholesterolemia; however, the long-term use of the FDA-approved inhibitor ezetimibe is limited by its adverse effects, motivating the search for safer alternatives. In this study, an integrated in silico strategy combining molecular docking, lipid-embedded all-atom molecular dynamics simulations, principal component analysis, and MM/PBSA binding free-energy calculations was employed to evaluate plant-derived polyphenols as potential NPC1L1 inhibitors under physiologically relevant conditions. Four compounds, cis-resveratroloside, eriodictyol-7-O-glucoside, luteolin-7-O-glucoside, and 3,4-dicaffeoylquinic acid, exhibited superior binding affinity toward the NPC1L1 neck region compared to ezetimibe. Unlike ezetimibe, which occupied the deep binding cleft, these polyphenols preferentially localized to the upper-mid channel region and formed conserved π-π interactions with Phe1101/Tyr1102 and hydrogen bonds with Gln873/Leu877. Molecular dynamics analyses revealed enhanced complex stability, favorable binding energetics, and pronounced modulation of lipid-protein interactions near the TM7-TM8 loop, a critical cholesterol transport domain; notably, luteolin-7-O-glucoside and 3,4-dicaffeoylquinic acid displayed high lipid occupancy in this region, suggesting a steric blockade mechanism that may impede cholesterol internalization. Collectively, these findings provide molecular-level evidence that selected plant-derived polyphenols inhibit NPC1L1 via mechanisms distinct from ezetimibe, highlighting their potential as safer, next-generation cholesterol absorption inhibitors.

Introduction: Acute confusional state (delirium) is a common neuropsychiatric syndrome in hospitalized elderly and is associated with increased morbidity, mortality, length of hospital stay and healthcare expenditure. However, studies in Northeast India are scarce despite being clinically important. Aims: (1). To study clinical profile of elderly patients presenting with acute confusional state. (2). To find out the etiological and precipitating factors of acute confusional state. (3). To evaluate short term outcome of geriatric patients with acute confusional state. Materials and Methods: A hospital based observational study was conducted in Department of Medicine, Gauhati Medical College and Hospital during the period from July 2016 to June 2017. We included 80 patients, aged ≥ 60 years, who met the Confusion Assessment Method (CAM) criteria for an acute confusional state. We evaluated demographic variables, comorbidities, predisposing factors, precipitating causes, distribution of subtypes and outcomes. Results: Participants’ mean age was 70.81±8.82 years. The study population consisted of 60% males. Hypoactive delirium was the most frequent subtype (43.8%). The most common comorbidities were hypertension (73.7%) and diabetes mellitus (56.2%). The main predisposing factors were hypoalbuminemia (66.2%), frailty (60%) and poor activities of daily living (58.7%). The most frequent precipitating factors were infection (67.5%), hyponatremia (42.5%) and catheter/tube insertion (35%). The most common infectious etiology was urinary tract infection (31.2%). Most patients had several predisposing and precipitating factors at the same time. Conclusion: In older patients, there are multiple causes of acute confusional state, of which infection and metabolic disturbances are important. Early recognition of vulnerable patients and correction of reversible causes may reduce morbidity and improve clinical outcomes.

INTRODUCTION: Acinetobacter baumannii has been termed as an emerging pathogen which is involved in nosocomial infections mostly seen in Intensive Care Units (ICU). It has the ability to develop resistance to antibiotics which makes it difficult to treat. OBJECTIVES: To calculate the burden of Acinetobacter baumannii isolates from different clinical samples and also to determine drug resistance patterns METHODOLOGY: Clinical samples from January 2023 to December 2023 were processed and Acinetobacter baumannii isolates were identified by their colony morphology and biochemical reactions. The drug resistance patterns of these isolates were detected using different approved antibiotics by Kirby-Bauer disc diffusion test as per the CLSI guidelines. RESULTS:1418 samples were culture positive for Gram negative bacteria out of which 296 (20.87%) constituted of Acinetobacter isolates. Of these, 252 (85.14%) belonged to ICU patients. Rest 44 (14.86%) non-ICU cases were from gynaecology, surgery and otorhinolaryngology wards. The antibiotic susceptibility testing of the Acinetobacter isolates showed multidrug resistant patterns with resistance to 3rd & 4th generation cephalosporins, quinolones, penicillin, carbapenems, aminoglycosides, macrolides. CONCLUSION: Acinetobacter baumannii is a significant pathogen in ICU patients with multidrug isolates increasing progressively due to indiscriminate use of antibiotics. This stresses upon the rational use of antibiotics and strict infection control practices as the need of the hour to control its progress. Keywords: Multidrug resistant Acinetobacter baumannii, Antibiotic susceptibility, ICU

Slipped capital femoral epiphysis (SCFE) is typically a chronic condition associated with metabolic and biomechanical factors, whereas acute traumatic SCFE in a previously asymptomatic adolescent is uncommon and carries a higher risk of avascular necrosis (AVN). We report the case of a 15-year-old male who presented with acute right hip pain and inability to bear weight following high-energy trauma. Radiographs demonstrated an unstable SCFE with severe displacement and no radiographic features of chronicity. The patient underwent urgent closed reduction and percutaneous fixation using two 4.0 mm cannulated screws, consisting of one partially threaded and one fully threaded screw. Postoperatively, he was managed with staged non-weight-bearing followed by gradual return to full weight-bearing. At 12 months, the patient was asymptomatic with no radiological evidence of AVN or loss of reduction. Functional outcome assessment demonstrated excellent recovery, with a Non-Arthritic Hip Score of 97.5% and high Hip disability and Osteoarthritis Outcome Score values across domains, including pain (98.6), symptoms (98.5), activities of daily living (100), sports and recreation (93.75), and quality of life (100). This case shows a favorable short-term outcome following dual small-diameter screw fixation; however, given the single-case design and limited follow-up, no conclusions regarding implant superiority or reduction in AVN risk can be drawn. Further studies are required to evaluate this technique in unstable SCFE.