Context: Increasing resistance in gram-negative bacteria presents a critical problem. Limited therapeutic option has forced infectious disease clinicians and microbiologists to reappraise the clinical application of Colistin. Aims: Emergency of resistance to multiple drugs leaves behind very few therapeutic options to fight out carbapenemase resistant gram-negative bacilli (GNB). Our objective was to study the in vitro sensitivity of Colistin to carbapenemase GNB. Settings and Design: This is the 6 months retrospective study. Materials and Methods: Present study was carried out in the Microbiology department in a tertiary care hospital and teaching institute, during the study period (June-November 2013). A total of 782 GNB were isolated. Out of 782, 172 were carbapenemase producer which were taken for present study. The entire testing was done under strict internal quality control using American type culture collection (ATCC) strains. Results: During the study period, 782 were examined. Out of 782 strains, 172 were found to produce carbapenemase activity. Out of 172 GNB strains, 164 (95.34%) were sensitive Colistin. Out of 164, 57 (34.75%) isolates sensitive to Colistin were found to be positive for extended spectrum beta-lactamase (ESBL) and carbapenemase production and 107 (65.24%) produced only carbapenemase. Among the resistant strains (08), 3 (37.5%) showed both carbapenemase and ESBL production and 5 (62.5%) were found to be positive only for carbapenemase production. Conclusions: Use of Colistin as therapeutic option can be increased by better understanding of the pharmacokinetics and pharmacodynamics of Colistin and its methanesulphate will allow the design of appropriate dosing regimens for maximizing efficacy while minimizing toxicity and the development of resistance.

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The risk of mothball poisoning is more in developing countries, where there is poor consumer protection; often products are poorly labeled and in most of the cases, consumers do not have product details. Naphthalene containing mothball poisoning may present late with anemia; and in malaria prone environment such as ours, there is tendency of miss-diagnosis, if history of exposure is not sort. Therefore, the case of a 2-year-old boy who presented 48-hours after exposure with severe anemia warranting blood transfusion is reported.

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Objective: In this study, we aimed to evaluate the last 7-year rates of maternal mortality and the causes of maternal mortality in Manisa including Aegean region in the western part of the country. Study design: Maternal mortalities in Manisa determined by Maternal Mortality Commission were examined between January 1, 2006 and December 31, 2012. The classification of maternal mortality was performed as directly, indirectly, and incidentally. The annual rates and numbers of maternal deaths, causes of death, and demographic data were obtained from the records. Maternal mortality ratio is calculated as the number of women who die during pregnancy and childbirth, per 100,000 live births. Results: A total of 32 maternal deaths cases were reviewed between 2006 and 2012. A total of seven incidental maternal deaths of 32 were not evaluated. A total of five direct maternal deaths and 20 indirect maternal deaths were recorded. Maternal mortality rate (per 100.000 per live births) was 28.86 in 2006. This ratio decreased to 10.7 in 2012. Considering the leading causes of maternal death, the diseases of the circulatory system complicating the pregnancy and puerperium (28%) rank first. When direct maternal deaths are only evaluated, the most common cause was hemorrhage, which was followed by the disseminated intravascular coagulation. In all, six over eight (42%) maternal mortality in which delay model was detected were recorded as matched with third. Conclusion: In conclusion, an incentive to demand primary pregnancy advisory service is necessary for minimizing indirect maternal deaths and the need of medical staff must be fulfilled. Postpartum monitoring will be performed during the postnatal period especially in the first 24 h. Sensitivity must be showed for the training of medical staff that will perform emergency obstetric care when required.

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Chromoblastomycosis (CBM) is a rare chronic fungal infection of skin and subcutaneous tissue caused by dematiaceous fungi. We report herein a case of chromoblastomycosis, which appeared clinically as an implantation dermoid cyst in a 68-year-old male. The study emphasizes the need for clinical suspicion, awareness of the entity, and diligent search for sclerotic bodies in histopathology. Early diagnosis and treatment can prevent untoward complications.

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