Post-COVID multisystem inflammatory syndrome in adults: a study from a tertiary care hospital in south India

Background & objectives: There are limited data from India on the post-COVID multisystem inflammatory syndrome in adults (MIS-A). The objective of the present study was to evaluate the clinical profile of patients with MIS-A admitted to a tertiary care centre in southern India. Methods: This single-centre retrospective study was conducted from November 2020 to July 2021, and included patients aged >18 yr admitted to the hospital as per the inclusion and exclusion criteria. Results: Nine patients (5 male, mean age 40±13 yr) met the criteria for MIS-A. Five patients had proven COVID-19 infection or contact history 36.8±11.8 days back. All patients were positive for SARS-CoV-2 IgG antibody, negative for COVID-19 PCR, and had negative blood, urine and sputum cultures. All patients had fever and gastrointestinal (GI) symptoms, and five patients had left ventricular dysfunction. All patients had neutrophilic leucocytosis at presentation and elevated biomarkers such as C-reactive protein serum procalcitonin, D-dimer and ferritin. The majority of the patients (7/9 i.e. 77.78%) were treated with intravenous hydrocortisone (50-100 mg q6h-q8h). Six patients recovered completely whereas three patients expired. Interpretation & conclusions: Fever and GI symptoms were the most common presentation of MIS-A. Elevated serum procalcitonin may not be useful in differentiating bacterial sepsis from MIS-A. Most patients responded to corticosteroids.

Incidence Of Pyramidal Lobe And Levator Glandulae Thyroideae Of Thyroid Gland In Adult Cadavers: A Morphological Study With Its Surgical Perspective

Background: Thyroid gland a brownish red, highly vascular endocrine gland consisting of two lateral lobesconnected by an isthmus. It lies in front of the second, third and fourth tracheal rings. It is one of the commonestglands well known for its developmental anomalies, ranging from common to rare ones. The thyroid surgeonmust have full knowledge of the anatomy of the thyroid gland, including all of its embryological, congenital, oracquired variations. Levator glandulae thyroideae (LGT), the persistent part of thyroglossal duct(fibromusculoglandular) stretches from the pyramidal lobe or upper border of isthmus of thyroid gland to thebody of the hyoid bone, usually on the left side. Presence of the pyramidal lobe (thyroid tissue remnant ofembryological origin located in the pretracheal region between the isthmus and the hyoid bone), may impactcompleteness of thyroidectomy. These variations will help the surgeons in planning thyroid surgeries in abetter and safe way.Materials and Observations: Dissection was carried out routinely in 34 cadavers of both sexes in which 2cadavers presented with LGT. In one cadaver LGT was extending from the left lobe of thyroid gland to hyoid bone.In the other cadaver in addition to the LGT, abnormal extent of the pyramidal lobe (PL). Thus accounting for anincidence of 5.80% variation, both the variations were noted in one male and one female cadavers.Conclusion: In the present study occurrence of thyroid anomalies (morphological variations) such as pyramidallobes along with LGT is vital, while dealing with thyroid surgeries in the neck region to avoid iatrogenic injuriesduring complete removal of the gland tissue. Knowledge of embryology of thyroid gland is vital as complexunderlying embryology produces substantial anatomic variations both in thyroid bed and elsewhere in theneck and mediastinum.

Awareness Of First Year Mbbs Students On Mbbs Degree And Their Ideas: An Unexpected Reality

Introduction: MBBS is a dream to cherish for all students. It is a course which is respected globally. Medicalcourse is perceived as stressful by many of the undergraduates all over the world. They join the course at an earlyage without awareness of the details of curriculum, the approaches to be followed for theoretical understandingand acquiring practical skills and developing right attitude to be a good humane doctor.Aims and objectives: To know the awareness of MBBS students about their knowledge of it as a profession andtheir attitude to know the surrounding atmosphere and approach of students while pursuing the course.Material and methods: This is a retrospective, observational study started after taking the approval of InstitutionalEthical Committee of Government Medical College, KADAPA. The material for the study consisted of volunteersfromfirst year MBBS students of Government Medical College, WHO gave an informed consent to express their ideasfor the Questionnaire.Results: Students gave their answers to the questionnaire voluntarily and the answers are noted in a table. Mostof the people had no awareness of the MBBS degree till they entered the course and feel MBBS is tough andexpressed thatthey want good surroundings and circumstances to study the course.Discussion: Most of the students did not complete their teenage when they have taken the decision to join MBBScourse. They had decided even during their schooling,inspired by school teachers and medical college faculty.They are interested in games and felt the subjects are tough and still want to study.Their concentration in classesis 75-100% and they want to read daily but are getting disturbed by various problems. They even have a dream todo super specialty and a small group want to participate in research.Conclusion: The present study facilitates faculty in understanding the interests of students, circumstances forunder performance in examination and their problems. This provides for designing a teaching method to explainthe subject in an understandable way and for developing newer teaching and learning techniques.

A comparative study of medical termination of pregnancy between 8-12 weeks with misoprostol versus mifepristone along with misoprostol at tertiary care hospital

Introduction: Medical method of abortion has advantages over surgical methods as it is noninvasive. Hence, no complications of anesthesia and administration of drugs is easy in medical methods. There is a need for evolving a safe and effective method for safe and effective method for terminating pregnancy in the first trimester. Aim: We have taken up the present study to know the efficacy of combination of mifepristone and misoprostol versus single drug misoprostol alone for 1st trimester abortion. Materials and methods: It was a Cross-Sectional Study carried on pregnant women coming for MTP under family planning op at CKM hospital for 2 years. The study included two groups Group-A and Group-B. Group-A consisted of 50 randomly selected cases received Vaginal Misoprostol 600 micrograms stat dose followed every 4th hourly by 400 micrograms for 24 hours, for a maximum of 4 doses. Group-B has 50 cases received Oral Mifepristone 200 mg and simultaneously 600 micrograms of vaginal Misoprostol stat dose followed every 4th hourly with 400 micrograms vaginal Misoprostol for a period of 24 hours maximum 4 doses. Depending on response USG was done within 24-48 hours in both studies and rescan after 2 weeks. V. Aruna Devi, M. Nagalakshmi, P. Rajitha. A comparative study of medical termination of pregnancy between 8-12 weeks with misoprostol versus mifepristone along with misoprostol at tertiary care hospital. IAIM, 2018; 5(10): 63-72. Page 64 Results: Among Group B subjects 86% had expulsion within 5-10 hrs and remaining 14% had expulsion within 10-15 hours. Among Group A subjects 76% required >24 hrs for expulsion, 10% required 20-24 hrs, 6% required 15-20 hrs and 8% needed 10-15 hrs for expulsion. The difference between grouping and induction to abortion interval was found to be statistically significant. In Group A, 15 subjects (30%) had complete expulsion of products. 35 subjects (70%) required D&C. In Group B, 43 subjects (86%) had complete expulsion, 7 subjects (14%) required D&C. The difference between grouping and final outcome was found to be statistically significant. Majority of study subjects who require D&C were present in Group A compared to Group B. The difference between grouping and D&C was found to be statistically significant. Conclusion: Thus combination of Mifepristone and vaginal Misoprostol is more efficacious than vaginal Misoprostol alone.

Liquid Chromatographic Assay for the Analysis of Kanamycin sulphate nanoparticles in Rat after intramuscular administration: Application to a Pharmacokinetic Study.

A rapid reversed-phase high performance liquid chromatography (RP-HPLC) method was developed for the determination of Kanamycin sulphate (KS) in PLGA nanoparticle formulation. A new formulation of KS loaded PLGA nanoparticles (NPs) was prepared by double (multiple) emulsion process in our laboratory. The desired chromatographic separation was achieved on a Phenomenex C18column under isocratic conditions using UV detection at 205 nm. The optimized mobile phase consisted of a mixture of 0.1 M disodium tetraborate (pH 9.0) and water (25:75, v/v) supplemented with 0.5 g/L sodium octanesulphonate at a flow rate of 1 mL/min. The linear regression analysis for the calibration curves showed a good linear correlation over the concentration range of 120-840µg/ml, with correlation coefficients of (r2 0.9997). The system was found to construct sharp peaks for KS and IS with retention times of 4.08 and 5.49 min, respectively. Transmission electron microscopy studies on MFX NPs demonstrated particle size < 100 nm. An average encapsulation efficiency of 74.34% was obtained for NPs. In vitro studies showed zero-order release and about 95% drug being released within 12 days in PBS (pH 7.4). In conclusion, the proposed optimized method was successfully applied for the determination of in vitro and in vivo release studies of KS NPs.

Angiographic Aspects of Myocardial Bridges.

Introduction: The segment of epicardial coronary artery that traverses intramurally through the myocardium and bridged by a bunch of cardiac muscle fibers is called tunneled artery or intramural artery. The band of cardiac muscle fibers passing over the tunneled artery segment is named as myocardial bridge. During angiography milking effect is observed during systole due to the external pressure of muscle fibers on the tunneled artery that leads to narrowing of vessel lumen and further ischemia. Materials & Methods: It is a prospective study performed from 2012- 2015 in cardiac centers available around Tirupati, Andhra Pradesh, South India. A total number of 2015 adult patients who underwent diagnostic coronary angiography were evaluated to detect myocardial bridges. With the informed consent the relevant data was collected from the patients and analyzed. Results: The prevalence of myocardial bridges was 3.17%. Among the 2015 patients 70.7% are males and 29.2% are females. Among 64 myocardial bridge positive cases 62.5% were male and 37.5% were female patients. Regarding coronary dominance 84% were right dominant and 14.4% were left dominant and 1.6% are balanced. The percentage incidence of myocardial bridging according to dominance was 3.01% for right dominant patients, 4.12% for left dominant patients and 3.1% for balanced dominant patients. In all the myocardial bridge positive cases they were located on the left anterior descending artery (LAD). According to diagnosis the patients with normal coronaries were 22.6%, patients with MILD CAD were 17.9%, patients with single vessel disease were 23.4%, patients with two vessel disease were 14.7% and the patients with triple vessel disease were 21.3%. The 64 myocardial bridging cases were grouped in to three groups according to their age. Incidence of double bridges was observed in 3 cases of which 66.7% males & 33.3% in females. Conclusion: These results shows that Andhra Pradesh population are with high angiographic incidence of myocardial bridges (MB’s), when compared with other population in India. We observed more lengthy bridges which may cause luminal reduction of coronary vessel and myocardial ischemia (MI), we also observed higher incidence of MB’s in male patients but systolic luminal reduction is more in female patients then in males. These observations suggest that the risk of MI will be more for the female patients with MB’s.

Comparison of shear bond strength of self‑etching fluoride releasing adhesives with and without pumice prophylaxis.

Context: Despite the advances in orthodontic material and treatment mechanics, the placement of fixed appliances increases the risk of enamel demineralization. The development of fluoride release adhesives has attracted considerable interests because the combined use of antimicrobials and fluoride enhances the cariostatic effect. Aim: To compare the shear bond strength (SBS) of fluoride release adhesives with established orthodontic adhesives and assess failure mode using adhesive remnant index (ARI). Settings and Design: The present study included 80 maxillary premolars which were randomly divided into four groups (n = 20) and were further subdivided into two subgroups A ‑ Pumice prophylaxis (PP) and subgroup B ‑ No PP (n = 10). Materials and Methods: Stainless steel brackets were bonded with Transbond XT, Transbond plus (TP) color change adhesive, Light Bond, and Clearfil protect bond. After debonding, the ARI was used to assess the mode of bracket failure. Statistical Analysis: The data were analyzed using two‑way analysis of variance, Post‑hoc Tukey Honest significant differences test, and Chi‑square test. Results: The mean SBS of Group 4 was comparably higher regardless of PP. Brackets bonded with TP showed a comparable SBS to conventional Transbond XT. The ARI scores were predominately 2. Conclusions: Fluoride releasing adhesives combined with antibacterial monomer can play a vital role in reducing white spot lesions by enhancing the cariostatic effect especially in noncompliant\medically compromised patients.

Percentage Incidence, Morphology and Morphometry of Myocardial Bridges: A Cadaveric Study.

Introduction: Myocardial bridging is the term used when a segment of major epicardial coronary artery runs intramuscularly under the tunnel formed by fibers of myocardium that bridges instead of it’s normal or routine epicardial path. In the literature there are varying reports on clinical implications of myocardial bridges from protection against atherosclerosis to myocardial ischemia, as well as leading to infarction and sudden cardiac death. Materials and Methods: 150 adult formalin fixed human hearts which were available in the department of Anatomy and Forensic Medicine, S.V.Medical College, Tirupati, Andhra Pradesh, India. These hearts were dissected and observed for the presence, location, type, number and direction of myocardial bridges and their association with coronary dominance. With the help of digital calipers morphometric parameters (length, width& thickness) of myocardial bridges and length of blood vessel underneath the myocardial bridge were measured, noted and photographs were taken. Results: The overall incidence of myocardial bridges was 20.6%( 31/150). Among these 18.6% (28/31) were on left anterior descending (LAD) artery and 2% (03/31) were on posterior interventricular (PIV) artery. The direction of muscle fibers in the bridges were oblique to the direction of the coronary vessels in majority of cases. Length, width and thickness of myocardial bridges were in the range of 12-69.7mm, 3.74-8.6mm and 1.3-3.87mm respectively. Conclusions: Myocardial bridges may be associated with wide range of clinical problems. Contraction of myocardial bridge may results in vascular compression and myocardial ischemia. Knowledge on morphology and morphometric details of myocardial bridges facilitates cardiologists in diagnosis, planning therapeutic strategies and prognostic predictions.

The implementation of problem-based learning in collaborative groups in a chiropractic program in Malaysia / 보건의료교육평가

PURPOSE: Problem-based learning (PBL) is usually conducted in small-group learning sessions with approximately eight students per facilitator. In this study, we implemented a modified version of PBL involving collaborative groups in an undergraduate chiropractic program and assessed its pedagogical effectiveness. METHODS: This study was conducted at the International Medical University, Kuala Lumpur, Malaysia, and involved the 2012 chiropractic student cohort. Six PBL cases were provided to chiropractic students, consisting of three PBL cases for which learning resources were provided and another three PBL cases for which learning resources were not provided. Group discussions were not continuously supervised, since only one facilitator was present. The students' perceptions of PBL in collaborative groups were assessed with a questionnaire that was divided into three domains: motivation, cognitive skills, and perceived pressure to work. RESULTS: Thirty of the 31 students (97%) participated in the study. PBL in collaborative groups was significantly associated with positive responses regarding students' motivation, cognitive skills, and perceived pressure to work (P<0.05). The students felt that PBL with learning resources increased motivation and cognitive skills (P<0.001). CONCLUSION: The new PBL implementation described in this study does not require additional instructors or any additional funding. When implemented in a classroom setting, it has pedagogical benefits equivalent to those of small-group sessions. Our findings also suggest that students rely significantly on available learning resources.

Comparative effects of mature coconut water (Cocos nucifera) and glibenclamide on some biochemical parameters in alloxan induced diabetic rats

In the present study, comparative effects of mature coconut water (Cocos nucifera L., Arecaceae) and glibenclamide in alloxan induced diabetic rats were evaluated. Diabetes mellitus was induced in Sprague-Dawly rats using alloxan monohydrate (150 mg kg-1 body weight). Treatment with lyophilized form of mature coconut water and glibenclamide in diabetic rats reduced the blood glucose and glycated hemoglobin along with improvement in plasma insulin level. Elevated levels of liver function enzymes markers like alkaline phosphatase, serum glutamate oxaloacetate transaminase and serum glutamate pyruvate transaminase in diabetic rats were significantly reduced on treatment with mature coconut water. In addition to this, diabetic rats showed altered levels of blood urea, serum creatinine, albumin, albumin/globulin ratio which were significantly improved by treatment with mature coconut water and glibenclamide. Activities of nitric oxide synthase in liver and plasma L-arginine were reduced significantly in alloxan induced diabetic rats while treatment with mature coconut water reversed these changes. The overall results show that mature coconut water has significant beneficial effects in diabetic rats and its effects were comparable to that of glibenclamide, a well known antidiabetic drug.

Identification of DNA damage in marine fish Therapon jarbua by comet assay technique.

The marine fish Therapon jarbua was exposed to acute concentration of mercuric chloride (HgCl2). In static acute toxicity bioassays at 24, 48, 72 and 96 hr LC50 values were estimated for each concentrations such as control, 2, 1, 0.5, 0.25 and 0.125 ppm, respectively. DNA damage (single-strand break) was also studied in gill, kidney and blood tissues at single-cell levels in the specimens exposed to different acute doses of HgCl2, by applying single-cell electrophoresis (comet assay). Dose- dependent responses were observed in DNA damage in all tissues. A comparison of DNA damage in all tissue at two concentration namely, 0.125 and 0.25 ppm indicated that the gill cells (maximum damage as 249.3 and 289.7 AU) were more sensitive to the heavy metal exposure than kidney (maximum 225.17 AU) and blood cells (maximum 200.3 AU). This study explored the utility of the comet assay for in vivo laboratory studies using fish for screening the genotoxic potential for various agents.

To evaluate the involvement of autonomic nervous system during pre and post menstrual phases in young women.

Background: During reproductive life, Women undergo many types of behavioural and hormonal changes, which influence various functions of body. ANS provides physiological adaptive background for these changes. The main aim of this study is to carry out autonomic function tests during various phases of menstrual cycle. Method: Different Methods were used to evaluate sympathetic and Parasympathetic activity. This study was carried out in two different phases of menstrual cycle viz. premenstrual phase (late luteal phase-LL) and post menstrual phase (early follicular phase –EF). Results: The autonomic function tests and heart rate variables were recorded and data was tabulated for Statistical evaluation with student paired “t” test. P 0.05 was considered as statistically significant. The tests for sympathetic activity were compared during pre and post menstrual phases. It was observed that pulse rate, blood pressure and cold pressor test were statistically more significant (p<0.01), while orthostatic variation in arterial blood pressure was statistically significant (p<0.05) in premenstrual phase as compared to post menstrual phase of menstrual cycle. For parasympathetic activity it was observed that heart rate response, expiratory: inspiratory ratio and valsalva ratio were statistically not significant (p>0.05) in both pre and post menstrual phases of menstrual cycle. Conclusion: In this study the responses to various sympathetic tests were significantly altered in premenstrual phase as compare to that of postmenstrual phase, reflecting the significant increase in the sympathetic activity. These changes may be due to gonadal steroids imbalance during post menstrual phase (EF) and premenstrual phase (LL) of menstrual cycle which in turn affects HPA axis and ANS significantly. Significant increased sympathetic activity responses indicate an augmented stress system.

GC-MS determination of bioactive components of Erythropalum scandens Bl., Bijdr.

Erythropalum scandens Bl., Bijdr (Erythropalaceae) known to the Kanikkar as “Vaathavallikodi” is an important medicinal plant. The Kanikkar tribe, inhabitants of KMTR, Western Ghats, Tamil Nadu use this plant to relief from rheumatic pain. The present investigation deals with GC-MS analysis of ethanol extract of the above said plant. Forty one compounds were identified.

Involvement of autonomic nervous system in isometric handgrip in healthy young subject.

Background: HRV can be considered a relatively simple, noninvasive and sensitive method for studying autonomic modulation, purpose of the present study was to determine whether readily measured blood pressure (BP) indices and responses to autonomic reflex tests could be used as surrogates of short-term heart rate variability. Different Methods were used to evaluate sympathetic and Parasympathetic activity. Results: The autonomic function tests and heart rate variables were recorded and data was tabulated for Statistical evaluation. A two tailed P value less than or equal to 0.05 (5%) were considered statistically significant. Heart Rate Variability in Male Mean R-R interval and SDNN of time domain analysis were highly significant on comparing supine to standing (P<0.001),Similarly LF, HF power, Total Power and LFnu of frequency domain analysis were highly significant on comparing supine to standing (P<0.001) and in Females also it is same. Conclusion : Considering the results our data indicate a decrease in HRV that seems to be expressions of a reduction in autonomic modulation in postural change from supine to standing erect both in male and female subjects. The findings suggestive of a shift in cardiac autonomic regulation towards sympathetic activation in response to real life stressors which also includes the decrease in parasympathetic modulation and no significant correlation between readily measured blood pressure indices to heart rate variables in both male and female groups, we suggest that mean heart rate, SBP, DBP and RPP cannot be used as surrogates of HRV. However, observations need to be made in healthy subjects belonging to various age groups and in patients with conditions known to be associated with autonomic deregulation.

Cytogenetic evaluation of traffic policemen occupationally exposed to vehicular exhaust.

Background & objectives: Automobile exhaust consists of many toxic components and is considered to be a major health concern in urban areas. Traffic policemen are occupationally exposed to vehicular exhaust during the traffic control. Hence, the present study was aimed to evaluate genotoxic effects of vehicular exhaust in traffic policemen in Hyderabad, south India. Methods: Analysis of chromosomal aberrations was carried out in 136 traffic policemen, including 78 non smokers and 58 smokers who were exposed to vehicular exhaust for a period of 1-28 yr. For comparison, 115 healthy males including 69 non smokers and 46 smokers of the same age group and socio-economic status (who were not exposed to any chemical or radiation at their workplace) were studied. Results: A significant increase (P<0.05) was observed in the mean frequency of chromosomal aberrations in non smoker and smoker traffic policemen (6.48 and 8.96 respectively) when compared to their respective control groups (3.35 and 4.30). According to the age a significant increase in the frequency of chromosomal aberrations was observed both in control and exposed groups (P<0.05). As the duration of exposure increased in traffic policemen, there was a corresponding increase in the frequency of chromosomal aberrations. Interpretation & conclusions: Cytogenetic damage was more pronounced in smokers when compared to non smokers. Age and duration of exposure also appear to play a vital role in causing cytogenetic damage. Thus the present study suggests that the induction of cytogenetic damage might be due to the cumulative effect of smoking, age and duration of exposure to vehicular exhaust.

Ramelteon: a melatonin receptor agonist for the treatment of insomnia.

Ramelteon is a novel MT1 and MT2 melatonin receptor selective agonist recently approved for the treatment of insomnia characterized by difficulty in sleep onset. It is a nonscheduled drug since it lacks the potential for abuse and does not interact with neurotransmitter receptors most associated with these phenomena. Although the effects of ramelteon use > 5 weeks are unknown, the available data confirms its safety and efficacy for short-term use. Clinical use and future research should uncover more information about ramelteon's properties.

Bone marrow involvement at presentation in pediatric non-haematological small round cell tumours.

Pediatric small round cell tumors (SRCT) are a group of neoplasms occurring in children, which have in common a cytomorphology of groups of small round cells with scanty cytoplasm. The common SRCT encountered are neuroblastoma, retinoblastoma, Ewing's sarcoma/peripheral neuroectodermal tumor (PNET), rhabdomyosarcoma and lymphoma which show varying degrees of bone marrow involvement and bone marrow evaluation forms a part of the initial staging procedure. This study was undertaken to evaluate marrow involvement at presentation in pediatric non hematological SRCT. 7833 bone marrow aspirates done over a period of three years in different malignancies were analysed and of these 180 aspirates were performed in patients of pediatric non hematological SRCT at presentation. These cases were evaluated in detail for incidence of marrow involvement. Thirty two (17.7%) cases showed marrow involvement and these cases have been analysed with respect to the primary tumor. The SRCT showing involvement of bone marrow included neuroblastoma (48.8%), retinoblastoma (11.1%), Ewing's sarcoma/PNET (8.6%) and rhabdomyosarcoma (3.2%).These findings are discussed in the light of available world literature.

Development of a purification method of pure primary lymphocytes for cell viability assays

The maintenance of pure primary lymphocytes culture for long periods may be difficult because of its inability to divide continuously. In addition, lymphocytes separation methods such as Ficoll-Paque, RBC lysis and immunomagnetic microbeads separation may have some affect on cell viability. The objective of this study is to determine various types of lymphocytes purification methods, in order to prolong primary lymphocytes culture to 72 hours. The second objective is to use these primary lymphocytes as targets for quantitative and qualitative cell viability assays when analysing the action of toxins isolated from natural products. Human blood was drawn and purified by using Ficoll-Paque, RBC lysis or immunomagnetic separation column method in various combinations. The purified lymphocytes were also grown with and without the growth enhancement factor, concanavalin-A. Cell viability assays were carried out for 72 hours at 24 hours interval. The lymphocytes purified using RBC lysis method, with or without concanavalin-A can prolong 100% cell viability for 72 hours whilst lymphocytes purified using Ficoll-Paque and supplemented with concanavalin-A showed an increase in cell viability of over 250% at 72 hours incubation. It was observed only lymphocytes purified using Ficoll-Paque followed by the immunomagnetic microbeads separation method and supplemented with concanavalin-A showed overall cell viability increase, reaching 300% at 72 hours incubation. This method was a reliable model to test the cytotoxicity of the Bacillus thuringiensis parasporal inclusion, suggesting that the method achieves the objectives of the study.

AmpC beta-lactamase producing multidrug resistant strains of Klebsiella spp. & Escherichia coli isolated from children under five in Chennai.

BACKGROUND & OBJECTIVES: AmpC beta-lactamases are Group I cephalosporinases that confer resistance to a wide variety of beta-lactam drugs. Plasmid mediated AmpC beta-lactamases has been discovered most frequently in isolates of Klebsiella pneumoniae, K. oxytoca, Salmonella, Proteus mirabilis and Escherichia coli. The present study was undertaken to study the occurrence of multidrug resistant and AmpC beta-lactamase producing Klebsiella spp. and Escherichia coli in children less than five years of age as this age group is very susceptible to intestinal and extraintestinal infections. METHODS: A total of 116 isolates of Klebsiella species and 32 isolates of Esch. coli were tested for resistance to cephamycin such as cefoxitin, third generation cephalosporin (3GC) antibiotics (ceftazidime, cefotaxime, ceftriaxone), ampicillin, amikacin, cephaloridine, cefuroxime, co-trimoxazole, gentamycin, imipenem and tetracycline by disc diffusion method. Isolates found resistant to cefoxitin were tested for the production of AmpC beta-lactamases by three dimensional extract method. Transconjugation experiments were done to study the transfer of drug resistance and AmpC beta lactamase production from AmpC producing Klebsiella and Esch. coli isolates to a recipient Esch. coli strain (K12 J62-2). RESULTS: Twenty eight isolates (24.1%) of Klebsiella spp. and 12 (37.5%) of Esch. coli were found to be AmpC beta-lactamase producers; 66.6 per cent and 81 per cent of Klebsiella and Esch. coli isolates respectively showed resistance to all the 3GCs. All the strains were found to be sensitive to imipenem. Eighty four (72%) of Klebsiella isolates and 20 (62.5%) of Esch. coli were found to be resistant to cefoxitin. Transfer of cefoxitin resistance to the recipient strain was observed in all the AmpC producing strains of Klebsiella spp. Of the 12 AmpC producing strains of Esch. coli, only 4 (33.3%) showed the transfer of cefoxitin resistance to the recipient strain. INTERPRETATION & CONCLUSION: This study has shown the occurrence of AmpC beta-lactamase producing Klebsiella and Esch. coli strains in children in Chennai. Since AmpC beta-lactamase production is frequently accompanied by multiresistance to antibiotics, therapeutic options become limited resulting a need for new measures for the management of Klebsiella and Esch. coli infections. Also failure to identify AmpC beta-lactamase producers may lead to inappropriate antimicrobial treatment and may result in increased mortality. Detecting plasmid mediated AmpC beta-lactamase producing strains is technically difficult and the phenotypic tests for AmpC detection are not well defined. If an investigational AmpC beta-lactamase inhibitor was made available for diagnostic testing, it could be useful in combination with a suitable cephamycin to confirm AmpC production.