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Background: Epilepsy is one of the most prevalent neurological conditions among the elderly. Age-related epileptogenic disorders as well as the ageing itself pose a risk for seizures in the elderly. The lack of witnesses, non-specific symptoms, and transient symptoms make the diagnosis challenging in the elderly. Aim: This study aimed to assess the various presentation and aetiology for the seizure disorder in the elderly population. Materials and Methods: A total of 125 elderly patients ≥60 years with new onset seizure were included in the study. Demographic data, co-morbidities, and clinical presentation of seizure were elicited. Hemogram, liver and renal function tests, random blood sugar, electrolytes, and serum calcium were analysed. Computed tomography (CT), magnetic resonance imaging (MRI) brain, and electroencephalogram (EEG) were performed. Results: Seizure was seen predominantly in the males with age group of 60-70 years. Generalized tonic-clonic seizure was the commonest presentation, followed by focal seizures. The leading causes of seizures were cerebral vascular accidents, metabolic conditions, and alcohol. CT brain was abnormal in 49%, and 73% of the patients showed abnormality in MRI brain. EEG was abnormal in 17.3% of patients. Temporal lobe infarction was the commonest, trailed by parieto-temporal and frontal lobe involvement. Conclusion: Seizures in the elderly have varied clinical signs and aetiology. An awareness about these atypical presentation and aetiology is essential for the early diagnosis and management to prevent morbidity.
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INTRODUCTION: In the Intensive care unit (ICU), hyperglycemia is often observed; commonly associated with pre-existing diabetes or pre-diabetes or in nondiabetic patients. This study aimed to assess the role of admission blood sugar levels with outcomes in ICU patients. METHODS: A total of 100 patients above 18 years of age were included in the study. A detailed history regarding the patient's age, sex, and any chronic illness were taken. Heart rate, systolic blood pressure, and Glasgow coma scale (GCS) scores were recorded. Admission blood glucose level, blood urea, total leucocyte count, and serum electrolytes were measured; and the outcome was noted. RESULTS: The number of diabetics was significantly higher (65.5%) in the random blood sugar (RBS) ≥180 group. Hyponatremia was significantly associated with hyperglycemia. Patients with hyperglycemia had serum bicarbonate <18. A significantly greater number of patients with hyperglycemia had GCS scores of <8, and required mechanical ventilation. The duration of ICU stay and non-survivors were significantly higher in the hyperglycemia group. Random blood sugar at admission as a factor to assess outcome showed a sensitivity of 68.4 and specificity of 59.3 with a cut-off value of 197. CONCLUSION: Admission of random blood sugar was significantly associated with poor outcomes. More stringent surveillance as well as routine blood glucose checks at the time of hospital admission should be emphasized.
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New lipopeptide homologues (AF3, AF4, and AF5) with antifungal activities against Candida and Cryptococcus spp. were purified from a cell-free supernatant of Bacillus subtilis RLID 12.1. The lipopeptides AF3, AF4, and AF5 were identified with the same peptide sequence Asn-Pro-Tyr-Asn-Gln-Thr-Ser with variations in the fatty acid branching type and chain length (anteiso-C17, iso-C17, and iso-C18, respectively). Upon comparing the three homologues for MICs against 81 Candida (n = 64) and Cryptococcus (n = 17) clinical isolates and their cytotoxicities, we found that AF4 was the most promising antifungal lipopeptide, since it demonstrated 100% inhibition at geometric mean MICs of 3.31, 3.41, 3.48, and 2.83 µg/ml against Candida albicans, Candida tropicalis, Candida auris, and Cryptococcus neoformans, respectively, with low hemolysis values (<6%) and 50% inhibitory concentrations (13.31 µg/ml). The additive effects among the homologues AF3, AF4, and AF5 were evaluated against three Candida species, along with the cytotoxicity studies. Five combinations exhibited good additive interaction effects: AF3/AF4 (at corresponding concentrations of 4 and 4 µg/ml [4/4 µg/ml]), AF3/AF5 (4/4 µg/ml), AF3/AF5 (2/4 µg/ml), AF4/AF5 (4/4 µg/ml), and AF4/AF5 (2/4 µg/ml) in planktonic cell inhibition and AF3/AF4 (4/4 µg/ml), AF3/AF5 (4/4 µg/ml), and AF3/AF5 (2/4 µg/ml) in the inhibition of biofilm formation. However, combinations AF3/AF4 and AF3/AF5, which showed >70% cell survival with low hemolysis (<5%), were found to be comparatively effective. We describe here the additive effects of lipopeptide homologues showing reduced cytotoxicity against mammalian cells; these combinations might serve as a potent antibiofilm-forming substitute.