Characterization and anti‑microbial susceptibility of bacterial isolates: Experience from a tertiary care cancer center in Delhi.

BACKGROUND: Hospitalization for fever in cancer patients is associated with considerable morbidity, mortality, and cost. AIM: The aim of this study was to study the bacterial spectrum and susceptibility patterns of pathogens in culture positive patients from the oncology unit of our hospital. METHODS: We retrospectively reviewed the medical records of patients admitted in our cancer center (medical, radiation, and surgical oncology) from January to December 2013. Blood and respiratory secretions from the indoor patients were evaluated. RESULTS: Of the total 693 samples, 76.4% were Gram‑negative and 23.6% were Gram‑positive. The most common bacterial isolates among Gram‑negative organisms in blood were Escherichia coli, Salmonella and among the Gram‑positive organism were Staphylococcus aureus and Enterococcus. Among the blood isolates extended spectrum of beta‑lactamase, multidrug‑resistant (carbapenem‑resistant) and pan resistant bugs were seen in 47%, 15%, and 5% of the blood isolates. Among the Gram‑positive organisms, 25% respiratory isolates were vancomycin‑resistant Enterococci. CONCLUSION: We observed a high incidence of Gram‑negative isolates with clinically significant resistance to first‑line antibiotics such as cephalosporin’s, piperacillin tazobactum, and fluoroquinolones.

Idiopathic pulmonary hemosiderosis: clinical profile and follow up of 26 children.

OBJECTIVES: To describe the clinical details and follow up of children with idiopathic pulmonary hemosiderosis. DESIGN: Retrospective case series. SETTING: Pediatric chest clinic of a tertiary care hospital. SUBJECTS: Children diagnosed as suffering from idiopathic pulmonary hemosiderosis (IPH). METHODS: Charts of patients diagnosed as IPH were reviewed for clinical features and treatment regimen. Diagnosis was based on presence of iron deficiency anemia, chest radiography and demonstration of hemosiderin laden macrophages in bronchoalveolar lavage (BAL), gastric aspirate, or sputum. Treatment consisted of oral prednisolone, hydroxychloroquine (HCQ) and inhaled corticosteroids (ICS). RESULTS: The common clinical features in 26 children with IPH (mean age 75 months) included: cough, breathlessness, fever, hemoptysis and wheezing in 26 (100%), 22 (85%), 19 (73%),15 (58%) and 14 (54%) children, respectively. Clubbing, hepatomegaly and splenomegaly was seen in 16 (62%), 15 (58%) and 10 (38%) children, respectively. Hemosiderin laden macrophages were documented in BAL and gastric aspirate in 92% and 30% patients, respectively. Symptoms did not recur in 17 patients who received prednisolone and HCQ initially. 5 patients had recurrence of symptoms and required short courses of oral prednisolone, 4 patients required frequent courses of prednisolone and were started on azathioprine. Older age, longer duration of illness, history of hemoptysis and jaundice were associated with poor response. CONCLUSION: Treatment with prednisolone and hydroxychloroquine followed by inhaled corticosteroids may improve survival in children with IPH.

Prevalence of coronary risk factors in non-insulin dependent (type 2) diabetics.

OBJECTIVES: A cross sectional study was conducted to find the prevalence of coronary risk factors in non-insulin dependent diabetic (NIDDM) patients and to compare and co-relate these risk factors in type II diabetics with and without electrocardiographic and/or symptomatic evidence of coronary heart disease (CHD). METHODS: One hundred sixty-seven consecutive NIDDM patients (77 males, and 90 females) attending the diabetic clinic at Dr. RML Hospital, New Delhi were studied. Only known NIDDM cases, already on treatment and without any history of ketosis or congestive heart failure were included. Coronary risk factors comprising of age, gender, duration and treatment for diabetes, smoking, physical activity, hypertension, truncal obesity, lipids, microalbuminuria (semiquantitative) and glycemic control have been particularly ascertained in all the cases. The data was analysed using 'Epi Info version 6.0'. RESULTS: The mean age of patients was 53.12 year and 8.86 year was the mean duration of diabetes. 28.6% of the diabetic men were found to be currently smoking and/or consuming alcohol, 82% were involved in sedentary physical activity and 20.4% had family history of CHD. Central obesity was observed in 46.7% of the cases; more so in females. 31.74% of cases were hypertensive; more females than males had hypertension (33.8% vs 30%). Poor glycemic control (HbA1c > = 9.5%) was seen in 16.8% of the cases. In about 52.5% of the total group hypertriglyceridemia was noted. Microalbuminuria could be found in 35.93%. CHD was diagnosed in 15.57% of cases in this study. CONCLUSIONS: The present study revealed that high levels of serum cholesterol (p = 0.000004), LDL (p = 0.00003), HbA1c (p = 0.002), microalbuminuria (p = 0.000006) and hypertension (p = 0.00006) are significant associates of CHD in NIDDM (both the sexes). Among the female NIDDM cases, in addition BMI (p = 0.01), Waist-hip ratio (WHR) (p = 0.003) and low HDL level (p = 0.008) are important correlates of CHD. Multiple logistic regression analysis was used to allow for confounding between variables. Microalbuminuria alone entered the 'best' model for CHD prediction. Other risk factors, though significant, provided inadequate models for CHD prediction.

AIDS awareness among nursing students of Delhi.

A total of 233 students of nursing school affiliated to a major hospital of Delhi were surveyed anonymously employing a predesigned, pretested and self-administered questionnaire. Although, 78.6 per cent students knew that AIDS stands for "Acquired Immuno-deficiency Syndrome," 15.5 per cent students were unaware of the fact that AIDS had reached India. Majority of them were aware of various aspects of HIV/AIDS. However, they also had few misconceptions particularly regarding HIV transmission. Contrary to our belief, only one-fourth students acquired AIDS information from scientific journals. One training session on AIDS conducted for a small group of students could not bring any significant change in their knowledge. Findings suggest organization of AIDS-training sessions at regular intervals from the very inception of nursing programme to impart complete and correct knowledge of these future Florence Nightingales regarding various aspects of HIV/AIDS and for removal of misconceptions.

Serum adenosine deaminase, 5'-nucleotidase & alkaline phosphatase in breast cancer patients.

Serum levels of adenosine deaminase (ADA), 5-nucleotidase (5'-NT) and alkaline phosphatase (ALP) were studied in 25 patients of carcinoma breast and 25 normal subjects. Adenosine deaminase was found to be the better probable parameter for the detection of cancer and to assess the development of various stages of cancer whereas 5'-nucleotidase had only diagnostic significance. Serum alkaline phosphatase levels were important for assessing the spread of cancer at secondary sites. After mastectomy a significant decrease was found in the levels of serum ADA and 5'-NT whereas no variations were found in case of serum ALP.