Morbidity pattern of communicable diseases in a tertiary care hospital in metropolitan city of western Maharashtra

Background: In India, infectious diseases continue to be predominant with emerging non-communicable diseases, imposing a double burden of diseases on health care system. Hence, the tertiary health care hospital-based study was done to compare the morbidity pattern of communicable diseases with respect to non-communicable diseases. Methods: A 2 years’ record-based data of admitted patients was collected in a tertiary health care hospital. The data was analysed using Microsoft Excel version 365. Significance of association and difference in proportions has been checked with chi-square test and Z test for SEDP respectively at significance level of 0.05. Results: During the study period of two years, 6818 patients were admitted in the hospital, of which 74.51% suffered from communicable diseases while 25.49% suffered from other types of disease including non-communicable diseases. Of the 5080, patients with communicable diseases, 57.74% were males and 42.26% were females. Communicable diseases and non-communicable diseases had male predominance (p<0.05) and was higher amongst age group 0-15 years (p<0.05). Hospital stay was prolonged in patients suffering from communicable disease (p<0.05). Significant increased difference was found in AFI, Malaria, Dengue and in Leptospirosis prevalence and significant decreased difference was found in acute gastroenteritis, IV, Covid-19, Respiratory infections and enteric fever (p<0.05). Conclusions: Communicable diseases continue to be a major threat to public health system in India. Through effective surveillance programmes, any change in trends of disease can be identified and suitable measures can be adapted to control and prevent it.

Knowledge, attitude, and perception of prescribers about antimicrobial stewardship in a tertiary care hospital

Background: Irrational antimicrobial use has contributed to amplification and spread of antimicrobial resistance (AMR). Antimicrobial stewardship by healthcare personnel can reduce AMR. The World Health Organization (WHO) has established a worldwide action plan to address AMR, including free online availability of open WHO courses. So, our study sought to ascertain knowledge, attitude, and practice (KAP) of healthcare personnel concerning AMS at tertiary care hospital. Methods: Study was conducted as a KAP survey among practitioners (faculty, senior and junior residents) from several departments of Government Medical College, Aurangabad, Maharashtra. A validated questionnaire with 30 questions was prepared and distributed to 100 participants. The data collected in MS excel was analyzed with descriptive statistics and results expressed as mean and standard deviation, frequencies, and percentages. Results: Response rate was 16.7% (n=100). Knowledge on AMS was observed among doctors’ with >80% near correct responses in each question. Insignificant knowledge gap was found comparing between faculty members, senior residents, and junior residents (p>0.005) in the knowledge, attitude and practice of antimicrobial use. All participants felt that ASP is a requirement of hospital, and it minimizes healthcare expenditures and negative impacts of inappropriate AM prescribing. Conclusions: All HCPs have a knowledge gap on ASP, although there is no significant difference in knowledge, attitude, and practice of antimicrobial use between faculty members and senior and junior residents. This demonstrates importance of faculty members taking lead in incorporating more practice and education into ASP.

Detection and Comparison of RAPD & SSR Primers in Genetic Diversity of Ocimum sanctum

Aims: To Analysis of genetic variability in Tulsi (Ocimum sanctum) genotypes by using RAPD & SSR Markers.Place and Duration of Study: Department of Plant Biotechnology at K.K.Wagh College of Agricultural Biotechnology, Nashik.Methodology: Ocimum tenuiflorum Linn., commonly known as Tulsi, is an aromatic plant with significant traditional and medicinal value. To assess the genetic diversity and relatedness of six Tulsi genotypes (Krishna, Ram, Lavangi, Pandharpuri, Daisil, and Kapoori), molecular techniques were employed. The genotypes were collected from Nagarjuna Medicinal and Aromatic Plant Park at Dr. P.D.K.V. Akola. DNA isolation was performed using alcohol fixation without liquid nitrogen, and the genotypes were analyzed using RAPD and SSR primers for molecular characterization.Results: Genetic diversity analysis of six Tulsi genotypes (Krishna, Ram, Lavangi, Pandharpuri, Daisil, and Kapoori) was performed using RAPD and SSR markers. Five RAPD primers produced 15 bands, with 11 bands showing polymorphism (73.3%) and 4 bands showing monomorphism (26.7%). The PIC value ranged from 0.28 to 0.49 (average: 0.40). Four SSR primers generated 9 bands, with 8 bands showing polymorphism and 1 band showing monomorphism. The PIC value ranged from 0.24 to 0.57 (average: 0.39). The Jaccard coefficient revealed moderate to high similarity in RAPD (0.40 to 0.73) and SSR (0.44 to 0.88) analyses. The UPGMA dendrogram separated the genotypes into two main clusters. Cluster 1 included Krishna, Lavangi, Ram, Pandharpuri, and Daisil Tulsi, while cluster 2 consisted of Kapoori Tulsi. The SSR dendrogram also formed two clusters, with Krishna, Lavangi, Ram, Daisil, and Kapoori genotypes in cluster 1, and Pandharpuri Tulsi showing dissimilarity and forming cluster 2.

Study of the prescription pattern of anti-depressants in a tertiary care hospital: a prospective observational study

Background: One of the most important public health priorities are psychiatric disorders. Prescribing medications play a crucial role in providing good health care. Therefore, there is a need to understand prescription patterns at regular intervals. Methods: This was a prospective, cross-sectional, observational study conducted at the psychiatry department OPD of Government Medical College, Aurangabad (Maharashtra, India) from January 2021 to June 2022. Records of prescriptions were collected from the hospital management information system. Results: N=417 prescriptions were analysed. The male: female ratio was 1.25. Among total prescriptions analysed, selective serotonin reuptake inhibitors (SSRIs) were the most prescribed drug class (32.18%) followed by benzodiazepines (25.19%) and atypical antipsychotics (19.97%). Drugs prescribed as fixed dose combinations (FDC) were 2.10%. Most of the patients received polytherapy in which most patients constituted of two drug therapy (46.28%) and 34.53% of patients received monotherapy. In the patients managed by monotherapy, SSRIs were the most prescribed (29.16%), followed by atypical anti-psychotics (26.38%) and benzodiazepines (24.30%). Prescriptions with generic names were 93.12%. The average number of drugs per encounter was 1.88. Drugs prescribed from the essential drugs list (India) were 41.66%. Drugs prescribed from the essential medicines list (WHO) were 47%. The total number of prescriptions with injections 0.23%. Conclusions: Prescribing patterns were according to the WHO-DUS parameters. Most patients were prescribed generic medicines. SSRIs, benzodiazepines and tricyclic antidepressants were the most prescribed drug class.

Studying drug prescription pattern of dermatology OPD of an Indian tertiary care hospital- a prospective, observational, cross-sectional study

Background: Studying prescription patterns helps prescribers to provide rational and cost-effective medical care. Drugs prescribed for skin disorders by a specialist differ in terms of numbers and the selection of drug class, necessitating periodic prescription audits and drug utilization studies. Methods: This prospective, cross-sectional, observational study was conducted at the dermatology department OPD of Government Medical College, Aurangabad (Maharashtra, India) from January 2021 to May 2021. Digital records of prescription were collected from the hospital management information system (HMIS). Results: N=5338 prescriptions were analysed, 40.89% of patients were from the 21-35 years age group. Polytherapy was 62.96% and monotherapy 36.99%. Drugs prescribed by generic names were 18% and brand names were 82%. Topical drugs constituted 71.67% followed by systemic drugs 28.32% of total prescriptions and the average injectables prescribed per encounter was 0.33%. Antifungals were most prescribed followed by steroids. The average number of drugs prescribed was 1.85 per encounter and the percentage of antibiotic prescriptions was 17.70%. Conclusions: The current study showed that WHO DUS indicators were followed. The results reflect rational prescription of drugs within the available resources.

Impact Of Communication Skills Training in Postgraduate Medical Education

Background: Effective communication is a key feature of optimal doctor-patient relationship. As the postgraduate curriculum lacks standardized teaching and assessment, this study aimed to assess effec-tiveness of training program on communication skills of postgraduate medical students. Materials and methods: A prospective, interventional study was conducted among first year postgrad-uate medical students from different clinical specialty. Training program included introduction to prin-ciples of communication with basics of doctor-patient relationship, administering informed consent, breaking bad news and counselling patients with HIV/cancer. Pre and post-test skill assessment by Fac-ulty and postgraduate (PG) self-rating was carried out using KEECC-A Assessment tool for seven core communication competencies. Perception of students on training program was collected via feedback questionnaire. Results: Forty-three postgraduate medical students participated. Statistically significant increase in communication skills scores was observed post training with mean post-test assessment scores of 24.26�94, p<0.001(rating by faculty), 25.19�76, p<0.001(PG self-rating) and high degree of internal consistency was found. Students perceived the training program as valuable and highlighted its im-portance as a part of curriculum. Conclusion: Training program significantly enhanced communication skills of postgraduate medical students. Integration of standardized teaching and assessment of communication skills is essential for better healthcare practice and optimal doctor-patient relationship.

Characterization, In Vitro Antioxidant And Hepatoprotective Activity Of Fungal Endophytic Extracts Of Andrographis Paniculata Leaves In Ccl4 Induced Hepatotoxicity

Objective: To isolate and characterize the endophytic fungi from the leaves of Andrographis paniculata for free radical scavenging antioxidant and hepatoprotective activity against CCl4 induced hepatotoxicity Methods: Two fungal endophytes, APLF-3 (Andrographis paniculata leaf fungi-3) and APLF-4 (Andrographis paniculata leaf fungi-4) were isolated from leaves of Andrographis paniculata to get chloroform (A3C, A4C), ethyl acetate (A3EA, A4EA) and n butanol (A3nB, A4nB) extracts. rDNA sequencing by PCR technique was carried out for identification of APLF-3 and APLF-4. All the APLF-3 and APLF-4 extracts were assayed for in vitro free radical scavenging activity against 2, 2-diphenyl-1-picrylhydrazyl (DPPH), hydroxyl radical and reducing power. Then, A4EA and A4nB were screened for hepatoprotective activity against CCl4 induced hepatotoxicity at 50 mg/kg and100 mg/kg doses. Results: The endophytic fungi, APLF-3 and APLF-4, were identified as Phyllosticta sp. ZLY-2010 isolate M13 and Aspergillus tubingensis strain Cs/7/2 respectively based on their morphological and molecular characterization. A4EA and A4nB showed significant in vitro free radical scavenging activity as compared to other extracts. A4EA and A4nB (50 mg/kg and100 mg/kg) reversed the increased serum biochemical parameters as compared to CCl4 treated group (p<0.001). A4EA and A4nB (100 mg/kg p. o) also restored the LPO, SOD and CAT levels. Conclusion: These findings suggested that the extracts (A4EA and A4nB) obtained from endophytic fungi APLF-4 contributed towards hepatoprotective activity.

Quantification of Neurons of Human Nucleus Accumbens by Fractal Analysis

Background: Analysis of volumetric and morphological neuronal data has been of keen interest to neurologists and neuroscientists because of its implications in pathological conditions such as schizophrenia, autism, obsessive compulsive disorder etc. One such part of human brain which has been explored in recent years is nucleus accumbens, a part of ventral striatum leaning against septal nuclei. An easier, freely accessible and cost effective technique to measure neurons of nucleus accumbens is the use of Image J -Fiji software. One of the applications of software is Fractal box analysis. This technique helps in analysis of the Euclidean geometry of neurons (Parameters such as length and breadth which are not good characteristics of multipolar neurons). Aim and Objectives: The present study was undertaken to study and analyze images of morphology of neurons of nucleus accumbens using Image J as an automated image analysis technique. Methods & Results: A qualitative cross sectional study was done using fifty five serial sections of nucleus accumbens. The 4 μ tissue sections were stained with hematoxylin and eosin. Freely downloadable Image J software was installed, images of serial sections were imported to Image J, processed and fractal box analysis was done. Fractal Box analysis of image of neurons of nucleus accumbens revealed statistically significant value (D= 1.99). Conclusion: Results of the present study can be extrapolated to correlate with pathological conditions associated with emotional and behavioral disorders involving nucleus accumbens Image J is cost effective software which is beneficial to identify and measure neurons of Nucleus accumbens

Isolation And Antimicrobial Susceptibility Pattern Of Staphylococcus Aureus.

Introduction- Staphylococcus aureus is one of the principal human pathogens that colonizes healthy individuals as well as causes severe infections in hospitalized patients. They have differential ability to spread and cause outbreaks in hospitals. The study was done to isolate S.aureus from various clinical samples and to know their antibiogram. Methodology- The study included a total of 312 Staphylococcus aureus strains isolated from various clinical specimens. The specimens received were processed further for identification by standard microbiological procedures like direct microscopic examination, culture and various standard identification methods. Antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method on Mueller-Hinton agar as per CLSI guidelines. Result- A total of 312 isolates of S. aureus were obtained from various clinical samples. Male to female ratio was 1.6:1. Infection rate was more in age group 46-60 years. Staphylococcus aureus isolates were more commonly obtained from surgery department (38.78%) followed by orthopedics. All the strains were 100% sensitive to Vancomycin, Netilmicin, Linezolid and Teicoplanin. Higher resistance was noted against Penicillin(94.87%), Trimethoprim/Sulfamethoxazole(72.44%).Lower resistance was noted against Nitrofurantoin(13.33%). Conclusion- The determination of the anti-microbial susceptibility is also crucial for an optimal therapy, for epidemiological purposes and for infection control measures.

Phytochemical screening and evaluation of analgesic and antiinflammatory activities of Phaseolus vulgaris linn., seeds in rodents.

With an objective of developing some novel analgesic and antiinflammatory natural agents with fast acting and low toxicity profile here in, the different extracts of Phaseolus vulgaris (Linn) seeds were evaluated for analgesic and antiinflammatory activities using glacial acetic acid induced writhing and carrageenan induced rat paw oedema method respectively. For screening of the extracts for analgesic and antiinflammatory activities aspirin and diclofenac were used as standard drugs respectively. Petroleum ether extract exhibited significant analgesic and antiinflammatory activities. The petroleum ether extract can be considered as a potential candidate for analgesic and antiinflammatory activities. The presence of steroids and flavonoids in petroleum ether extract of Phaseolus vulgaris Linn., seeds could be attributed for the analgesic and antiinflammatory activities.

Phytochemical screening and evaluation of analgesic, anti-antiinflammatory activities of Peganum harmala Linn., seeds in rodents.

The objective of this research work is to carryout the phytochemical screening and evaluate the analgesic, antiinflammatory activities of Peganum harmala Linn., seeds. In this study different extracts of Peganum harmala (Linn) seeds were evaluated for analgesic and anti-inflammatory activities using glacial acetic acid induced writhing and carrageenan induced rat paw edema models respectively. For analgesic and anti-inflammatory activities aspirin and diclofenac were used as standard drugs respectively. The ethyl acetate extract showed significant analgesic and anti-inflammatory activities, thus it can be considered as a potential candidate for analgesic and antiinflammatory activities. The presence of alkaloids, steroids, flavonoids in ethyl acetate extract of Peganum harmala (Linn) seeds could be attributed for the claimed analgesic and anti-inflammatory activities.

Study of effect of Oligohydramnios on maternal and fetal outcome.

Background: Amniotic fluid acts like a cushion and helps in growth of fetus, decrease in amniotic fluid volume may lead to increased risk of intrauterine growth retardation (IUGR), meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and congenital abnormities. Objective: This study was done to see effects of Oligohydramnios on fetal outcome in the form of neonatal morbidity and mortality and maternal morbidity. Material and Methods: Present study was done in 100 patients who have completed 28 weeks of pregnancy and above with oligohydramnios, selected randomly after satisfying inclusion and exclusion criteria. Detailed examination done and oligohydramnios was confirmed by measuring AFI on ultrasonography. Associated complications, type of delivery conducted, and fetal outcome for perinatal morbidity & mortality studied. Results: Common causes for Oligohydramnios were idiopathic (56%) and PIH (24%). Most common reason to perform caesarean was fetal distress. Oligohydramnios was related to higher rate of growth retardation and neonatal intensive care unit admission. Conclusion: Oligohydramnios is frequent occurring condition. This condition requires antepartum and intrapartum care. Due to oligohydramnios intrapartum complications, perinatal morbidity and mortality are increasing. Decision between vaginal delivery and caesarean section should be well balanced. Unnecessary maternal morbidity can be prevented. Timely intervention can reduce perinatal morbidity and mortality.

Case Study: Magnetic Resonance Imaging of Squamous Cell Carcinoma of Perianal Region, Vulva and Cervix.

Squamous cell carcinoma is the second most common skin carcinoma, which most commonly affects sun-exposed areas. However squamous cell carcinoma can rarely involve the anal and perianal region. It has been found in association with human papilloma virus infection, uterine cervix dysplastic changes and high-grade anal intraepithelial neoplasia (AIN). We report a case of extensive carcinoma of the perianal region, vulva and cervix. A 49 years old female came with complaint of swelling in the right inguinal region since one year, pain and swelling in the gluteal region since 7-8 months. Contrast enhanced CT scan and MRI were done which showed a mass involving the perianal region, vulva and cervix with a large inguinal lymph node. Biopsy revealed squamous cell carcinoma.

Clinical Profile of Multiorgan Involvement in Malaria.

Background and aims: In view of high incidence, increasing morbidity and mortality due to malaria in an endemic area like Bikaner, it was planned to study the clinical profile of multiorgan involvement in Plasmodium vivax, Plasmodium falciparum and mixed type of malaria. Material and methods: Prospective data were collected from 201 adult patients with multiorgan involvement, admitted in classified malaria ward and confirmed by asexual parasitemia in peripheral blood film. Results: Prevalence of renal failure was 57.7%, cerebral malaria 47.8%, jaundice 41.8%, severe anemia (hemoglobin [Hb] ≤5 g/dl) in 31.8%, severe thrombocytopenia, shock, septicemia in 19.9%, 12.4%, 8.96%, respectively. Out of this P. vivax was associated with renal failure in 10.4%, with cerebral malaria in 7.46%, with jaundice in 9.5% and with severe anemia in 3.5%. Multiorgan dysfunction was a major cause of death in 25.87% patients (18.4%, P. falciparum 6%, P. vivax 1.5%, mixed). Acute respiratory distress syndrome (ARDS) was found in 14 (7%) of patients out of which 13 expired. Conclusion: P. vivax which was previously considered to be benign, has now turned to be malignant. ARDS came out with the worst outcome. Early institution of dialysis and use of antimalarial drugs aggressively can result in better prognosis.

Reversal of CRF- and stress-induced anorexia by an ayurvedic formulation

Trikatu churna is one of the commonly used Ayurvedic formulations in the traditional system of medicine in India for the treatment of agnimandya, i.e. anorexia. Trikatu contains equal amounts of finely powdered rhizomes of Zingiber officinale Roscoe (Zingiberaceae) and fruits of Piper longum L. and Piper nigrum L. (Piperaceae). The chief objective of the study was to determine the antianorectic effects of three drugs individually and to compare these effects with the effect of Trikatu. The activity of the drugs was studied after anorexia was induced in rats by (1) physical stress arising from immobilization for 60 min; (2) intraperitoneal injection of Escherichia coli lipopolysaccharide (LPS, 100 μg/kg body weight); and (3) intraperitoneal administration of fluoxetine (8 mg/kg body weight). Similar doses of the extracts were tested on freely feeding rats and on rats that had been deprived of food for 20 h. Corticotrophin-releasing factor (CRF, 0.3 μg/rat) can induce anxiogenic-like behavior and reduced food intake. This model was also studied, and the results were compared. The components of Trikatu churna failed to individually reverse the inhibition of feeding. In contrast, Trikatu churna pretreatment reversed stress-, fluoxetine- and CRF-induced anorexia. The study provides strong evidence of the synergistic action of Ayurvedic formulas and also proves the ability of Trikatu churna to reduce stress and CRF-induced anorexia.

A study on pulmonary manifestations in patients with malaria from north-western India (Bikaner).

Background & objectives: Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) are responsible for most of the global burden of malaria. With changing spectrum of clinical presentation in malaria, pulmonary system involvement has always been under diagnosed. The present study was planned to estimate the pulmonary system involvement in patients with malaria from north-western India (Bikaner). Study design & description of the patients: Our study was conducted during 2007 to 2009 in 200 cases of severe malaria [Pf , Pv, and mixed (Pf + Pv)] with pulmonary involvement. It included adult patients of both sexes (145 males and 55 females) belonging to all age groups. The diagnosis of Pf and Pv was confirmed by demonstrating asexual form of parasites in peripheral blood smear and OptiMal test. Main outcome measures: Pulmonary involvement was observed in 30% (60/200) patients among which cough in 24% , dyspnea in 12%, acute respiratory distress syndrome (ARDS) in 7% , bronchitis in 3% and pneumonia in 1.5% were the major clinical manifestations of malaria. Metabolic acidosis and low oxygen saturation was observed in 7% patients. Chest X-ray abnormality in 11.5% patients, 7% had bilateral infiltrates, 1.5% had inflammatory patch and 3% had findings suggestive of bronchitis. Spirometry findings showed 17% patients had early small airway obstruction. All the patients with ARDS had poor disease outcome. Results & conclusion: Our results suggest that pulmonary system involvement was observed in patients infected with Pf and Pv. If these clinical presentations are ignored, it may lead to delay in diagnosis and can alter the outcome and prognosis of the disease. Therefore, early diagnosis of malaria induced ARDS can significantly affect the outcome.

Biphasic demyelination of the nervous system following anti-rabies vaccination.

Acute disseminated encephalomyelitis (ADEM) is an acute or subacute condition characterized by widespread multifocal neurological deficits of variable severity. We report a case of a 45-year-old man with ADEM following anti-rabies vaccine (ARV).

Comparative evaluation of efficacy of sodium fluoride, chlorhexidine and triclosan mouth rinses in reducing the mutans streptococci count in saliva : an in vivo study.

The primary objective of this study was to compare the efficacy of sodium fluoride (0.05%), chlorhexidine (0.12%) and triclosan (0.3%) mouth rinses in reducing the mutans streptococci count in saliva. 60 subjects in the age group of 12 to 14 years were selected from the schools of Mumbai and were equally divided into 4 groups. First 3 groups were test groups and the 4th group was control group. The subjects were instructed to rinse one full marked measure of mouth rinse for 1 minute, twice daily. Salivary samples were collected at baseline and after 2 weeks and cultured on M.S.B.agar. The number of mutans streptococci colonies were counted on agar medium. The results of the study confirmed that chlorhexidine mouth rinses are more efficient in reducing mutans streptococci count in saliva as compared to other mouth rinses.