Antimicrobial Resistance Pattern of Bacterial Isolates from Endotracheal Aspirate of Ventilated Patients at a Tertiary Care Hospital

Background: Respiratory infections among critically ill Patient are associated with high morbidity and mortality. Mechanically ventilated patients are at a high risk of acquiring respiratory infections due to complex interplay between the endotracheal tube, host immunity and virulence of invading bacteria. Irrational use of antibiotics increases the emergence of drug – resistant bacteria. Objectives: The aim of study was to investigate the bacterial isolates in the endotracheal aspirates of mechanically ventilated patients in ICU and see the antimicrobial resistance pattern of bacterial isolates. Methods: Analysis of E.T aspirates of 459 patients over a period of 1 year (Aug 14 to Aug 15) was done. Aspirates were cultured on Blood and MacConkey agar isolation and identification was done using conventional techniques and biochemical reactions. Antibiotic sensitivity testing was done by Kirby-Bauer disc diffusion method as per CLSI guidelines. Results: Out of 459 Samples 365 was found to be positive. Acinetobacter sp (44.65%) was the most common isolate followed by Klebsiella sp (18.63%), Pseudomonas sp (11.23%), Candida (10.46%), Escherichia Coli (7.94%), COPS (3.28%), CONS (2.46%), Enterococci (0.82%), and Citrobacter (0.54%). The gram-negative bacilli were mostly sensitive to Tigecycline, Colistin, Imipenem, Meropenem, Amikacin and Piperacillin/Tazobactam. Gram positive Cocci were mostly sensitive to Vancomycin, Linezolid and Gentamicin. Conclusion: The isolation and antimicrobial resistance pattern of the microorganisms is necessary for their effective management. Endotracheal intubation is one of the major risk factors in causing iatrogenic infections to patients. A local antibiogram for each hospital, based on bacteriological patterns and susceptibility is essential to initiate empirical therapy.

Epidemiological Study of Male Infertility.

Advanced male age has been associated with signicant reductions in pregnancy rates, increased time-to-pregnancy and increased subfecundity.The present study was aimed at analyzing the male factor causing infertility and epidemiological factors in the rural institute situated in the eastern part of Maharashtra. Aims and Objectives: Study the profile of male infertility in this rural area over a period of 20 years and correlate the various factors responsible for male infertility. Materials and Methods: The present study comprised of retrospective as well as prospective analysis of infertility cases over a period of 20 years. Analysis of the records was done for male factors thoroughly in relation to age, duration and type of infertility, age at marriage, addiction. Statistical Evaluation: Statistical analysis was done in EPI-6 software. Chi square test and variance analysis was used for analyzing the data. Observations:The incidence of primary infertility (62.00%) was higher as compared to secondary infertility (38.00%) in all the five blocks.The semen analysis reports revealed that the most affected age group was 31-40 years. The abnormalities of semen were 35.49%, 86.49% and 53.75% in smokers, alcoholics and in cases having more than one addictions respectively. Cases with no addictions were having the maximum of (82.96%) normozoospermic males. Conclusions:The relationship between smoking and alcoholism was evident. Both of these addictions were found to impair the reproductive functions in male.

The histopathology of chronic gastritis.

Chronic gastritis is a multifactorial disorder thought to be influenced by bacterial and host genetic factors. Histopathological examination is the mainstay of diagnosis, however features like the presence of Helicobacter pylori are difficult to evaluate on biopsy. We evaluated 120 gastric antral biopsies using the revised Sydney system. The density of the inflammatory infiltrate, H pylori and mast cells were evaluated. It was seen that the presence of H pylori is strongly associated with an acute and a chronic inflammatory infiltrate. The presence of neutrophils on biopsy is strongly associated with the presence of H pylori and with the density and the grade of the chronic inflammatory infiltrate. The chronic inflammatory response is an intermediary between the acute inflammatory process and glandular atrophy. The lymphocytic infiltrate is also a precursor lesion of the lymphoid follicles. The presence of mast cells does not appear to be related to any of the other inflammatory parameters. The presence of one feature is a strong indicator for the presence of other inflammatory features.

Modification of radiation induced changes in murine hepatic lipid profiles by garlic (Allium sativum Linn.) unsaturated oils.

Adult male Swiss albino mice were administered 74 kBq g-1 body weight of 45Ca in the presence and absence of garlic unsaturated oils, and the changes in total lipids, triglycerides, phospholipids and free fatty acids contents of liver were observed at various intervals from 1 to 14 days post-treatment. The results obtained indicate that garlic oils prevented rapid increase in hepatic total lipids, triglycerides and phospholipids and decrease in free fatty acids induced by radiocalcium and the values reached normal values earlier in garlic treated animals than in irradiated animals. Possible mechanism underlying the protective action of garlic oils is reported.

Mechanism of action of an eukaryotic initiation factor-2 (eIF-2) associated 67 kDa glycoprotein (p67) and an eIF-2 kinase (dsI).

Mechanism of regulation of eIF-2 alpha-subunit phosphorylation by dsI and p67 was studied. The results are as follows: (1) At low dsI concentration, p67 protected equimolar concentration of eIF-2. (2) At high dsI concentration, dsI efficiently phosphorylated eIF-2 alpha-subunit even when equimolar concentrations of both p67 and eIF-2 were present. Significantly increased p67 concentration was necessary to protect eIF-2 alpha-subunit at high dsI concentration. (3) dsI was also phosphorylated as it phosphorylated eIF-2 alpha-subunit. p67 inhibited both eIF-2 alpha-subunit and dsI phosphorylation similarly. (4) Although the [32P]-labelled dsI formed during the reaction could be effectively chased upon subsequent addition of excess unlabelled eIF-2 and ATP, the [32P] labelled eIF-2 formed under identical conditions, retained most of the radioactivity. (5) dsI coimmunoprecipitated with three subunit eIF-2 and p67 inhibited this coimmunoprecipitation reaction. It has been proposed: Three subunit eIF-2 and free p67 are in equilibrium with eIF-2 bound to p67 and, eIF-2.p67 complex is resistant to dsI phosphorylation. Activated dsI is already phosphorylated. At high concentration, dsI(P) can bind to free three subunit eIF-2 and form eIF-2.dsI(P) complex. dsI(P) in this complex then transfers its phosphoryl residue to eIF-2 and forms eIF-2 alpha(P) in an irreversible reaction. In a subsequent reaction, unphosphorylated dsI is autophosphorylated using [gamma 32P]-ATP and the cycle continues. Inhibition of eIF-2 alpha-subunit phosphorylation by p67 blocks this phosphorylation cycle and consequent dsI phosphorylation.

Myopic strabismus fixus convergens.

A case report of myopic myositis, a rare entity, leading to strabismus fixus convergens, occurring in a high myope at the age of 46 years is presented. The possible differential diagnosis along with the aetiopathogenesis is discussed.

Ectopia lentis et pupillae.

A rare case of congenital bilateral ectopia lentis et pupillae (ELEP) is reported in a 32 year old female presenting with complaints of diminution of vision in both eyes. Associations of optic nerve hypoplasia and myelinated nerve fibers are being reported for the first time in such a case. The aetiopathogenesis of ELEP is controversial. Combined neuroectodermal and mesodermal origin is being postulated for this syndrome on the basis of aforesaid abnormalities and presence of pupillary dilator muscle hypoplasia, "annular endotheliopathy", and persistent pupillary membrane in both eyes.