Isolation and Molecular Characterization of Extended Spectrum Beta Lactamase Producing Escherichia coli from Milk

Milk plays a major role as a source of nutrition in the diet but contaminated milk can be a source of harmful bacteria. Escherichia coli is opportunistic pathogen and is responsible for a wide range of infections. The prevalence of pathogenic multi-drug resistant extended-spectrum β-lactamase (ESBL)-producing E. coli is increasing and becoming a global concern. A study was carried out to isolate ESBL producing E. coli from 150 milk samples from Anand and around villages. Total 94(62.66%) samples were found positive as E. coli by isolation on MacConkey and Eosin Methylene Blue agar which were confirmed by primary & biochemical tests including Gram’s staining. Antibiotic sensitivity test (ABST) was performed against 6 antibiotics and isolates found resistant to Aztrionem: 58(61%), Cefoxitin: 20(21%), Ceftriaxone: 56(59%), Ceftazidime: 62(65%), Cefpodoxime: 34(44.73%) & Ceftazidime + Clavulanic acid: 8(8.5%). A total 34(36.17%) ESBL producing E. coli were phenotypically confirmed by ABST and Epsilometer test. Genotypic confirmation of 34 isolates was done by PCR and isolates found positive for bla CTX M-3 gene: 18(52.94%), bla CTX M-9 gene 6(17.64%), bla SHV gene: 5(14.70%) and bla TEM gene: 5(14.70%). In summary, analyzed milk samples were found to have a health risk for consumers due to contamination by ESBL producing E. coli, their pathogenicity and treatment failure as a result of antibiotic resistance

Effectiveness And Safety Assessment Of Fixed Dose Combination Of Non-Steroidal Antiinflammatory Drugs Prescribed For Orthopedic Patients

Objective: Many Fix Dose Combinations (FDCs) being introduced in India are usually irrational. The most pressing concern with irrational FDCs is that they expose patients to unnecessary risk of adverse drug reactions, for instance, pediatric formulations of nimesulide+paracetamol. Despite their wide clinical use, their gastro-intestinal toxicity is a major limitation. The aim of the present work was to evaluate the efficacy and safety of FDCs in non-steroidal anti-inflammatory drugs in the orthopedic department at a tertiary care teaching hospital. To study the effectiveness and safety parameters of fixed-dose combinations of Non-Steroidal Anti-inflammatory Drugs. Methods: This prospective, observational study was conducted among 150 out-patients of the orthopedic ward over a period of July 2013 to December 2013(Each combination with 50 patients). Three fixed-dose combinations utilized were paracetamol+diclofenac, paracetamol+ibuprofen and paracetamol+nimesulide. The effectiveness was analyzed by using Visual Analogue Scale (VAS) and Disease Activity Scale (DAS) and the safety criteria were analyzed by using the WHO probability scale and Naranjo scale. 150 orthopedic patients attending Out Patient Department were included. 50 participants for each of the combinations of fixed-dose combination (FDCs) of NSAIDs. Results: Out of 150 patients 33 patients developed adverse effects, and 17(51.51%) adverse effects due to the combination of Paracetmol+Nimuselide, 11(33.34%) adverse effects due to the Paracetamol+Ibuprofen and 5 (15.15%) were due to the combination of Paracetamol+Diclofenac. The maximum effectiveness (3.55±0.208) showed in the combination of paracetamol+diclofenac compared to the other two combinations. Conclusion: It was concluded from this study that the effectiveness and safety profile of PCM+DICLO is better than the other two FDCs.

Knowledge and awareness about Iron deficiency and megaloblastic anaemia among blood donors: a study at rural based tertiary care hospital.

Background: Voluntary blood donation is promoted in order to make the blood banking safe and successful. Research in the area of blood donation has found that, iron stores are influenced by regular blood donation if dietary intake of iron is inadequate. Awareness and knowledge among blood donors regarding iron and B12 deficiency and its prevention is very much required. Objective: To assess the knowledge and awareness about iron deficiency and megaloblastic anaemia among blood donors. Methods: A cross sectional study was conducted among the 500 voluntary blood donors during the span of 1 year at one of the blood bank of tertiary care hospital using prestructured questionnaire on the various aspect of iron and B12 deficiency/folate deficiency anemia. The data was analysed with the help of Microsoft excel and SPSS. Results: Out of 500 blood donors, 15.6% donors were regular blood donor. It was observed 60% blood donors were having knowledge of anemia in general. Iron deficiency and vitamin B12 deficiency were known to 42% and 31.6% donors, respectively. Only 20% donors could able to answer the acceptable level of hemoglobin require for donating the blood. About 42% donors were aware about importance of iron, folate and vitamin B12 in maintaining normal hemoglobin level. Majority (82.7%) of regular blood donors were willing to get information regarding iron, folate and vitamin B12 deficiency. Conclusion: Significant lack of awareness regarding iron and vitamin B12 deficiency was observed in regular voluntary blood donors. The present study recommends the provision of health education on iron and vitamin B12 deficiency as well as Iron, folate and vitamin B12 rich foods to regular blood donor to prevent anaemia among them.

Retrospective study of ABO & Rh blood groups in blood donors at Dharpur.

Background and Objectives: In these days of fast life nobody knows when he or she will be in urgent need of human blood for surgical or accidental causes. That is why to keep a record of blood donors with their blood groups may be of lots of help. This study was conducted to record the ABO & rhesus blood group pattern in blood donors at Blood Bank of GMERS Medical College, Dharpur - Patan. Methods: This is a retrospective study. After the permission of Departmental head and Medical Superintendant we used the data available at blood bank. Results: From the month May 2012 to June 2013 total 652 donors donated their blood. Out of which 640 were males and 12 were females. The commonest blood group found was B blood group in 42.63%, followed by O blood group in 26.38% , A blood group in 19.94% and AB blood group in 11.04%. While 96.01% donors were Rh positive and 3.99% donors were Rh negative. The maximum numbers of donors were between in age group 21-30 years. Conclusion: Blood group B is the commonest blood group followed by blood group O, A and AB. Most common age group is 21-30 years amongst the all donors.

Clinicopathological Profile of Acute Leukemia in Children.

Introduction: Acute leukemia is the most common malignancy in children of which acute lymphoblastic leukemia accounts for majority of the cases. The objective of this study was to see the clinical profile, hematological parameters and assessment of response to chemotherapeutic agents in acute leukemia. This was an observational prospective study involving 58 children conducted over a period of two years from September 2005 to August 2007 at the department of paediatrics, B.J. Medical College, Ahmedabad. Materials and Methods: Leukemia was suspected in children presenting with history of prolonged fever, pallor, hepatosplenomegaly, lymphadenopathy, abnormal bleeding or history of repeated blood transfusion. A complete history, clinical examination and relevant investigations were done to diagnose leukemia. After confirmation of diagnosis, patients were treated, followed up to first remission after receiving chemotherapy. Follow up bone marrow examination was done after induction phase to confirm remission. Complete blood count and CSF cytology were done periodically during intrathecal chemotherapy. Results: Out of total 58 patients, 49 (84.5%) were ALL and 9 (15.5%) were AML. Pallor (87.9%), fever (82.7%) and fatigue (86.2%) were most common presenting symptoms. Pallor (86.2%), splenomegaly (89.6%) and hepatomegaly (84.5%) were the most common clinical signs. Forty two patients (74.2%) presented with moderate anemia. Remission was achieved in 51 cases (87.9%) after intrathecal chemotherapy. Conclusion: ALL is more common than AML in children. With detailed history and clinical examination, timely diagnosis and initiation of appropriate chemotherapy commonly leads to remission in childhood acute leukemias.

Autoantibodies, immunoglobulins, complement and circulating immune complexes in acute malaria.

BACKGROUND: Malaria caused by Plasmodium vivax and Plasmodium falciparum is common in the Indian subcontinent. Studies conducted elsewhere have suggested that malarial infection causes intense immunostimulation. We screened patients with malarial infection for autoantibodies and measured the immunoglobulin, circulating immune complex and complement levels to determine the extent of immunological alterations in these patients. METHODS: One hundred adults with acute malarial infection confirmed by examination of the peripheral blood smear and 25 age- and sex-matched controls were studied. An autoantibody screen and serum immunoglobulin complement (C3 and C4) and circulating immune complex levels were measured at the time of admission and 4 weeks after they became afebrile. A direct Coomb's test was also done. RESULTS: Anti-ssDNA, anti-dsDNA and rheumatoid factor were positive at the time of admission in 51, 30 and 38 patients respectively. None of the controls were positive for these autoantibodies except for one who was positive for rheumatoid factor. The IgM, IgG and IgA levels were raised in 16, 25 and 36 patients respectively. Circulating immune complex levels were raised in 32 patients and complement C3 and C4 were low in 8 and 31 patients. Follow up studies at 4 weeks in 19 patients showed that the autoantibodies were negative. However, the immunoglobulin, C4 and circulating immune complex levels remained elevated. Six per cent of patients had a positive direct Coomb's test with reticulocytosis at the time of presentation. CONCLUSION: Acute malarial infection can cause false-positive results for anti-ssDNA, anti-dsDNA and rheumatoid factor and may also cause a rise in the serum immunoglobulin, complement and circulating immune complex levels.

False positive modified Widal test in acute malaria.

The present study reports results of modified Widal test carried out on 96 cases of acute malaria and 25 healthy controls. Out of the 96 patients studied, 30 had complicated P.falciparum (CPF), 36 had uncomplicated P.falciparum (UPF) and 30 had P.vivax (pv) malaria. Modified widal test was done to know the Widal titers due to Igm type of anti-salmonella antibodies, which is considered very specific for diagnosis of recent enteric fever. This test was positive in 14.58% and 10.41% of malaria patients for salmonella 'o' and 'H' titers respectively. On four weeks follow up most of the positive test become negative. Non-specific polyclonal B lymphocyte stimulation due to malaria was postulated to be responsible for this phenomenon.

Baclofen in trigeminal neuralgia--a clinical trial.

Baclofen is a new antineuralgic drug. A clinical trial with treatment by this drug on 20 patients of trigeminal neuralgia was done. The action of this drug is similar to that of carbamazepine, however the former gives less undesirable side-effects. Out of 20 patients under treatment by this drug, 45% were relieved completely from pain while in 20% intensity and/or number of attacks of pain was reduced to half and in 35% effectiveness of Baclofen could not be observed.

Klebsiella pneumoniae osteomyelitis in sickle cell anemia.

A case of Klebsiella pneumoniae osteomyelitis in a patient with sickle cell anemia is reported. The literature is briefly reviewed. The case is presented because of the rarity of Klebsiella pneumonia osteomyelitis in sickle cell disease.