Evaluation of a revised care plan for babies with retinopathy of prematurity during SARS-CoV-2 pandemic in India

Purpose: To analyze the impact of a revised care plan for retinopathy of prematurity (ROP) during SARS?CoV?2 pandemic in a tertiary eye care facility in eastern India. Methods: In a retrospective study, we analyzed the medical records of babies managed for ROP during the peak of the SARS?CoV?2 pandemic, with particular reference to the challenges, and the revised strategies addressing travel restrictions for five months, from April to August 2020. The strategy included selective referral (babies with higher treatment probability), longer follow?up intervals (babies with non?alarming findings), use of locally available workforce, and teleconsultation whenever feasible. Results: In the given period, 222 babies were examined versus 624 in the preceding year (P = 0.001). The average gestational age, birth weight, and postmenstrual age at presentation were 30.4 weeks, 1.31 kg, and 37.7 weeks, respectively. The first examination was on time in 40.1% of babies but was delayed by a median of 23 days in the remaining babies. In the cohort, 56.7% of babies had any ROP, and 27.9% required treatment (versus 8.8% in the previous year; P < 0.001). The intravitreal anti–vascular growth factor (anti?VEGF) injection was more often used than in the previous year (n = 72 vs 36; P < 0.0001). The treatment outcome was comparable before and after the SARS?CoV?2 lockdown period. There was no report of health issues among the care providers attributable to ROP care. Conclusion: The revised strategy resulted in a smaller pool of babies screened but a larger proportion of babies treated for ROP. This strategy could be used more profitably in future ROP care.

In vitro Assessment of Fosfomycin: A Beacon of Hope in Drug Resistant Organisms Causing Urinary Tract Infections

Introduction:Urinary tract infections (UTI) are the most common bacterial infections affecting humans.. Fosfomycin has been approved for use in uncomplicated UTI caused by E. coli and Enterococcus. However, data regarding sensitivity of organisms causing hospital acquired or complicated UTI is scarce worldwide. We aimed to determine the in vitro sensitivity of drug resistant organisms causing hospital acquired and complicated UTI towards fosfomycin. Materials and Methods:Over a 6 month period, urine samples were processed as per standard microbiological protocols. Bacterial isolates were identified by routine microbiological methods followed by automated methods. Antibiotic sensitivity tests were done for different antibiotics. Fosfomycin sensitivity was tested by disc diffusion assay and minimum inhibitory concentration (MIC) was determined by E test method. Results:A total of 248`organisms causing hospital acquired and/or complicated UTI were isolated of which E. coli 88(35.48%) was most common followed by K. pneumoniae78(31.45%) and P. aeruginosa 64(25.80%). Of 248, 92.74% (230/248) isolates were sensitive to fosfomycin. All the E. coli isolates were sensitive to fosfomycin with a low MIC (range 0.064­16 mg/L) while 97.43% (76/78) of the K. pneumoniae and 71.87% (46/64) P. aeruginosa of isolates were sensitive with a higher MIC (range 0.5­32 mg/L and 6­64mg/L respectively). Fosfomycin MIC geometric mean among E. coli, K. pneumoniaeand P. aeruginosa was; 1.05, 7.19 and 19.61 mg/L respectively. K. pneumoniae and P. aeruginosa showed a significantly higher geometric mean MIC compare to E. coli (P <0.0001).Conclusions:This study suggests that fosfomycin has the potential to replace the parenteral antibiotics for treating complicated or hospital acquired lower UTI especially in case of Enterobacteriaceae

Epstein-Barr virus DNA load and its association with Helicobacter pylori infection in gastroduodenal diseases

Helicobacter pylori and Epstein-Barr virus (EBV) infections are common worldwide. Although H. pylori infection is a major factor in gastroduodenal diseases, its role in association with EBV infection is unknown. Objective: To study the association of H. pylori infection and EBV DNA load in patients with gastroduodenal diseases. Methods: Biopsy samples were collected from 200 adult patients [non-ulcer dyspepsia (NUD) 100, peptic ulcer disease (PUD) 50, gastric carcinoma (GC) 50] undergoing upper gastrointestinal endoscopy. H. pylori infection was diagnosed by rapid urease test, culture, histopathology, PCR and Q-PCR. EBV DNA was detected by non-polymorphic Epstein-Barr nuclear antigen-1 (EBNA-1) gene based Q-PCR. Results: In patients with GC and PUD, EBV DNA was detected more often than NUD (GC versus NUD = 90 percent versus 37 percent, p < 0.001; PUD versus NUD = 70 percent versus 37 percent, p < 0.001). The dual prevalence of H. pylori infection and EBV DNA was significantly higher in patients with GC and PUD than in those with NUD. Median copy number of EBV DNA was considerably higher in GC and PUD than NUD (p < 0.01). The copy number of EBV DNA was significantly higher in H. pylori infected patients (p = 0.015). The number of ureA gene copies was also found to be significantly higher in PUD and NUD with presence of EBV DNA. However, in GC no significant difference was seen between EBV positive and negative status. Conclusion: There was a trend for higher EBV DNA load in H. pylori positive individuals suggesting a probable role of H. pylori in modulating the conversion of EBV to its lytic phase.