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Pseudomonas species are responsible for 10% of hospital acquired infection especially in an ICU set up and in burn patients. Metallo-beta lactamase production is the most common mechanism of resistance to carbapenem which is the most commonly used drug to treat Pseudomonas. Local prevalence of MBL producing Pseudomonas is important information to both microbiologist and clinician to formulate hospital infection control strategy. This cross-sectional descriptive study was conducted in a tertiary care hospital of western Odisha to detect MBL prevalence among clinical isolates of Pseudomonas species.METHODS187 Pseudomonas strains (165 P. aeruginosa and 22 P. putida) isolated in different clinical samples in Vitek 2 system were checked for imipenem resistance (MIC>8 µl/ml). All imipenem resistance strains were checked for MBL production by combined disc test with imipenem, and MBL production was confirmed by MBL E test.RESULTSAmong 187 Pseudomonas strains 12.20% were carbapenem resistant and 9% were MBL producing. About 74% of carbapenem resistant Pseudomonas strains were MBL positive. MBL positivity rate was much higher in Pseudomonas putida (27.20%) compared to Pseudomonas aeruginosa (7%) and in ICU (14.20%) compared to IPD (9.20%) or OPD (6.80%). Colistin was the most effective (97%) antibiotic against MBL producing Pseudomonas.CONCLUSIONSIt is better to prevent MBL Pseudomonas than to cure it as most of the antibiotics were found to be ineffective against it. In our study MBL production rate in clinical isolate of Pseudomonas was low (9%) compared to other studies in India.
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Although UTI is a female disease, males are also susceptible during the neonatal period and old age. Asymptomatic bacteriuria, cystitis and acute urethral syndrome are the most common clinical type. Etiological profile is variable in different geographical areas, but E. coli is the most common agent worldwide. Klebsiella, Proteus, Pseudomonas are important causes of hospital acquired UTI. Culture sensitivity of early morning mid-stream urine collected by clean catch technique is the gold standard method of diagnosis of UTI. Sensitivity to 3rd generation cephalosporins and cotrimoxazole is variable in different areas but aminoglycoside, nitrofurantoin and carbapenem are almost sensitive worldwide. Resistance to nitrofurantoin and carbapenem has been reported in many areas of world. Before starting empirical therapy, physician should know the local etiological profile and antibiotic sensitivity pattern of uropathogens. We wanted to study the etiological profile and antibiotic sensitivity pattern of urinary isolates in a tertiary care hospital of Western Odisha.METHODSEarly morning mid-stream urine samples of 730 clinically suspected UTI patients were collected by clean catch technique and sent to microbiology department. Cysteine lactose electrolyte deficient (CLED) agar media was seeded with urine with the help of 0.01 ml (4 mm) loop. After incubation for 24 hrs at 370C growth was observed and identified by Gram stain and biochemical tests. Antibiotic sensitivity was performed by disc diffusion method as per CLSI guidelines. Antibiotic sensitivity was performed for all Gram-negative bacteria, Enterococci and Staphylococcus.RESULTSAmong 730 samples, 238 (33%) showed significant bacteriuria and 63 % of significant bacteriuria samples were from female. Middle age females (36-50 yrs.) were more affected (38%) followed by old age (>50 yrs.) male (19%) and old age (>50 yrs.) female (18%). E. coli was the most common bacteria (31%) followed by Enterococci (18%). Fluoroquinolones like nalidixic acid and norfloxacin showed high resistance rate (31%, 42% in case of Gram-negative bacteria and 12%, 25% in case of Staphylococcus species respectively). Nitrofurantoin showed excellent sensitivity to both Gram-positive cocci and Gram-negative bacilli. (80% for gram-negative bacilli and 87 % for Staphylococcus species and 78% for enterococci species). Aminoglycoside and carbapenem showed excellent sensitivity to Gram-negative bacteria (81% and 92% respectively). Third generation cephalosporins showed poor sensitivity (48% to 53%).CONCLUSIONSEnterococci rather than Klebsiella species was the 2nd most common uropathogen in our study. Aminoglycoside was still useful for UTI. Nitrofurantoin was the best option for empirical therapy.
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Blood transfusion is an important lifesaving intervention, but it poses the risk of transmission of different infections like hepatitis B, hepatitis C, human immunodeficiency virus (HIV), Treponema pallidum (causing syphilis) and Plasmodium spp. (causing malaria) to the recipient. Seroprevalence of different transfusion transmitted infection (TTI) among blood donors is an indirect measure of these infections in the community. This study was conducted to assess the seroprevalence of different TTIs in blood donors attending blood bank of a tertiary care hospital of Western Odisha.METHODS12,241 samples over 8 years from both voluntary and replacement donors were processed for HBsAg, HCV, HIV by ELISA method and for syphilis by RPR test, for malaria by rapid card test. Positive samples were confirmed by PCR method for HBsAg, HCV, HIV and by TPHA test for Syphilis and by peripheral smear study for malaria. All the positive samples were rejected for transfusion and the seroreactive blood donors were sent to appropriate department for treatment.RESULTSAmong 12241 samples 0.96% (118/12241) samples were positive for TTI. 2.70% (328/12241) were voluntary donors and 1.87% (229/12241) were female donors. Seroprevalence of hepatitis B, hepatitis C, HIV, Syphilis and malaria were 0.62, 0.044%, 0.073%, 0.1% and 0.12% respectively. Hepatitis B showed significant decrease of annual prevalence over 8 years.CONCLUSIONSSeroprevalence of TTI was lower compared to other studies of India. Highest seroprevalence was seen in hepatitis B. Awareness about hepatitis B vaccination should be increased in that area. Voluntary blood donation and female participation should be encouraged in that area.
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Scrub typhus is a vector borne Rickettsial disease caused by Orientia tsutsugamushi and has been reported from tsutsugamushi triangle which includes India. It is a re-emerging pathogen in India including the state of Odisha. This study was conducted to determine seropositivity of scrub typhus in patients attending a tertiary care hospital of Western Odisha.METHODSFifty febrile patients who were negative for Malaria, Dengue and Leptospira attending a tertiary care hospital of Western Odisha were enrolled in the study. 3 ml of blood was collected, and serum was separated. IgM SD Bioline Tsutsugamushi lateral flow immunochromatography test was performed as per manufacturer instruction. Positive samples were confirmed by PCR method (Geno-Sen’s ST Real Time PCR).RESULTS20% of patients were positive for IgM SD Bioline Tsutsugamushi card test. 60% of positive patients were male. 20% of positive patients were having pathognomonic eschar. 60 % of infected patients were in the age group of 10 - 30.CONCLUSIONSIn this study, 20% of febrile patients were positive for Scrub typhus infection. So, it should be included in the differential diagnosis of a febrile patient in Western Odisha.
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BACKGROUND Enteric fever is a feco-orally transmitted disease with significant morbidity and mortality in India. Isolation of responsible bacteria from blood or bone marrow is the gold standard method for Enteric fever but it is seldom used now a days due to long turnaround time and higher cost. In developing country like India, relatively cheaper Widal test is used to diagnose Enteric fever. There are two methods of Widal test- slide agglutination test and tube agglutination test. The present study was done to compare efficacy of the slide agglutination test and tube agglutination in diagnosing enteric fever.METHODSAn OPD and IPD based cross sectional study was conducted from May 2019 to Oct 2019. A total of 100 patients with clinical suspicion of Enteric fever were included in the study. 15 ml blood was collected. Blood culture of all the samples were also performed by inoculating 10 ml of blood into appropriate blood culture media. Serum was separated from rest of the blood and serum was tested by both slide agglutination test and Widal tube agglutination test.RESULTSAmong 100 patients, slide agglutination test demonstrated positive result in 40(40%) samples and Widal tube agglutination test demonstrated positive result in 27 (27%) samples only. Among 40 samples positive by slide test 12 samples were negative by blood culture test. The slide test had a sensitivity of 93.33%, specificity of 82.86%, positive predictive value of 70% and negative predictive value of 96.67% and tube test had a sensitivity of 86.67%, specificity of 98.57% positive predictive value of 96.30% and negative predictive value of 94.52% considering blood culture as gold standard.CONCLUSIONSDue to higher sensitivity but poor specificity, slide Widal test should be used for rapid screening test and positive samples should be confirmed by Widal tube agglutination test.
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Aims: To assess the knowledge and attitude of post- graduate medical students regarding evidence based medicine (EBM) and to find out the barriers against its implementation, if any. Study Design: Medical college based cross-sectional survey. Place and Duration of Study: The study was carried out between October 2013 to March 2014, at a medical college in Kolkata, West Bengal, India. Methodology: Altogether 145 post-graduate medical students of clinical disciplines filled up a predesigned, pre-tested, structured questionnaire and data were analyzed by standard statistical procedures. Results: The mean knowledge score was found to be 13.46±3.10. The score was arbitrary, ranged from 0 to 20 and higher score corresponded to higher knowledge. The distribution of the mean knowledge score among <30 years (13.34±3.28) and ≥30 years (13.67±2.62) was the same across these two categories (P =.62). Large proportions of the respondents were not familiar with reputed EBM resources such as Cochrane data base (66.9%) and Best Evidence (67.6%). Use of Medline was also quite poor (35.9%). Nearly half of them did not think that EBM was focused on patient’s values and preferences and many believed that EBM would place another demand on the already overburdened residents and doctors. Quite a large proportion thought that EBM would be of limited value in clinical practice. However the mean attitude score (21.23±4.06) showed an overall favorable attitude towards EBM. There was a positive correlation between the mean knowledge and attitude scores (P =.008). The common barriers against the implementation of evidence-based medicine were “no ready access to resources” (68.3) and “never taught on the subject” (56.6%). Conclusion: Although many of the respondents were not adequately knowledgeable about evidence-based medicine and also quite a few had a negative attitude towards its practicality, the positive correlation between knowledge attitude scores suggested that imparting proper knowledge could bring about a positive change in this attitude.
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Background & objectives: Prevention of parent-to-child transmission (PPTCT) services are an integral part of National AIDS Control Programme and their critical appraisal is necessary for improving quality care. The present study was conducted to evaluate the performance of PPTCT services in West Bengal during April, 2008 - March 2009 and April 2009 - March 2010 and identify gaps in service delivery for making suitable recommendations. Methods: Data were collected from the Computerized Management Information System and validated by cross-checking records at each district. Focus group discussions (FGDs) were conducted among programme managers, counsellors and antenatal women attending the Integrated Counselling and Testing Centres. Performance indicators and outcomes of FGDs were analyzed. Results: The proportion of antenatal women tested declined in 2009-2010 from 2008-2009 (64.3 to 63.8%). Proportions of counseled cases also declined (72.5 vs. 68.4%). HIV positivity rates among those tested were 0.13 and 0.14 per cent, respectively in two years. Proportion of mother-baby pairs receiving nevirapine prophylaxis was increased by 5 per cent. Medical colleges, and category A districts having high HIV prevalence provided better services. Follow up services of HIV-exposed birth cohorts were grossly unsatisfactory. Interpretation & conclusions: Gaps were identified at each step of service delivery for which capacity building, improvement of infrastructure including laboratory services and ensuring emergency labour room testing up to the sub-district level were imperative. Outsourcing follow up services to other community based organizations may also be considered.
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A cross-sectional study was conducted among 199 (104 urban, 95 rural) male students of classes VIII and IX, of two schools, in urban and rural areas of West Bengal to compare the prevalence of protective factors, mental health issues, and violence among the urban and rural adolescents using a self-administered questionnaire. Higher proportion of urban students than rural (67.3% vs. 62.5%) reported that their guardians understood their problems. Mental health issues like loneliness (17.3% vs. 9.8%), worry (17.3% vs. 10.7%), and suicidal thoughts (19.2% vs. 14.1%) were higher among urban students. Physical fight (53.8% vs. 11.6%), bullying (46.4% vs. 17%), physical attack by family members (46% vs. 17%), and by teachers (53% vs. 10.7%) were all more in urban adolescents. Mental health- and violence-related issues were prevalent more among urban students than those among rural students in spite of having more protective factors suggesting the need of frequent supervision, monitoring, and support of adolescents.
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Globally, alcohol-abuse is a major cause of mortality and morbidity. Consumption of alcohol has increased in India in the recent decades. It is imperative to know the patterns of alcohol consumption among different types of consumers to launch a well-planned nationwide programme for the prevention and control of this devastating social pathology. This community-based, cross-sectional study was undertaken to identify the patterns of alcohol intake among different types of alcohol consumers and to assess the clinical signs of chronic harmful alcohol-use. A predesigned, pretested, semi-structured alcohol-use disorders identification test (AUDIT) questionnaire was used for interviewing males, aged >18 years, selected by random sampling from an updated household list of a randomly-selected sector of the service area of the Urban Health Centre in Chetla, Kolkata, West Bengal, India. Written informed consents were obtained from all the respondents. Relevant clinical examination for chronic harmful alcohol-use was done according to the AUDIT clinical screening procedures. The results revealed that 65.8% (150/228) were current consumers of alcohol; 14% were alcohol-dependents; 8% were hazardous or harmful consumers, and 78% were nonhazardous non-harmful consumers. The mean age of the respondents at the initiation of drinking alcohol was 20.8+5.9 years. Eighty-six percent of dependents (n=21) took both Indian-made foreign liquor and locally-made alcoholic beverages. The proportions of alcohol consumers who drank alone among alcoholdependents, hazardous or harmful consumers, and non-hazardous non-harmful consumers were 71.4%, 50%, and 7.7% respectively, and the difference was significant (p<0.01). Forty-one percent of the consumers drank at public places and workplaces, which may be socially harmful. About 38% of the dependents purchased alcohol from unlicensed liquor shops. Only 16% expressed concerns for their drinking habit mainly to the past illness. The proportion of the concerned respondents was higher in the hazardous and harmful drinking patterns than in the non-hazardous non-harmful drinking pattern, and the difference was significant (p<0.05). About 62% of the dependents had clinical signs of chronic alcohol consumption. The presence of a considerable proportion of alcohol-dependents, the low mean age at initiation of drinking alcohol, and the habit of drinking in public places and workplaces are the main areas that need special emphasis by intervention programmes.
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A community-based, descriptive, cross-sectional study was conducted in Purushottampur village of the Singur block, Hooghly, using a pre-tested, semi-structured questionnaire, to find out the prevalence of RTI / STI symptomatics among the general population aged 15 to 49 years, and to assess their profiles and health-seeking behaviors. Prevalence of (Reproductive tract infection) RTI / STI (Sexually transmitted infections) symptoms in the last 12 months was found to be 13.9 and 13.6% among males and females, respectively. The most common symptom was dysuria and vaginal discharge among males and females, respectively. Almost half of the STI symptomatics (52% male, 50% female) did nothing for their symptoms. Better health-seeking behavior was observed among females. About 9.4% of the males and 47% of the females sought advice from the clinic / hospital / health workers. Strengthening of activities of the existing national program among the general population is needed to build a positive health-seeking behavior that will ensure success of the syndromic management of RTI / STI.