Understanding Antimicrobial Resistance with perspective of One Health

The concept of "One Health" recognizes the intrinsic relationship among health of human, animal and environment as a whole. All facets of One Health are undermined by the irrational use of antimicrobials and AMR cannot be effectively contained without coordinated actions of all key stakeholders including community participation.

Effect of isotonic exercise on cardiovascular parameters in medical students with parental history of hypertension – An institutional study

Background: Hypertension (HTN) is one of the most common and a high-risk factor for cardiovascular disease. Aims and Objectives: This study aims to identify students who are at risk of developing HTN with positive parental history of HTN and to compare the effects of isotonic exercise on cardiovascular parameters among the students with and without positive history of parental HTN. Materials and Methods: A total of 50 students participated in the study out of which 21 students had positive history of parental HTN with at least one parent having history of HTN and 29 students had negative history of parental HTN. Baseline pulse rate (PR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) of the participants were recorded. Then, all the participants performed Harvard step test for 3 min. The SBP, DBP, and PR were measured immediately after stopping the exercise and after 3 min and after 5 min of stopping the exercise. Data were statistically analyzed using unpaired t-test and ANOVA. P < 0.05 was considered statistically significant. Results: PR recorded after 3 min of stopping of exercise was significantly higher in the participants with positive parental history of HTN than the other group. SBP recorded immediately and after 3 min and after 5 min of stopping exercise was significantly higher in the participants with a positive history of parental HTN as compared to the other group. However, no statistically significant difference was observed in DBP between the two groups. Conclusion: Students with positive parental history may have relatively higher risk of developing HTN in future as an exaggerated blood pressure response to exercise was observed in them in this study.

EEG microstates in resting condition in young indians

Objectives: The map topography analysis gives an idea of temporal dynamics of electric fields, which is reference independent, making the results unambiguous. These topographic maps remain stable for 80 to 100 milliseconds, abruptly shifting to a new topographic map configuration and remains stable in that state are called the ‘functional microstates’ as described by Lehmann et al (1987). There has been no study done in the resting state eye closed and eye open conditions showing the microstate maps in healthy Indian subjects in resting eyes open and resting eyes closed condition using 128 channel EEG. So our study aim was to assess the microstates in resting eyes closed and eyes open condition. And to compare the microstate parameters such as mean duration, global explained variance (GEV) and time coverage between eyes closed and eyes open condition. Materials and Methods: A cross-sectional and observational study on 20 indian subjects (Mean age- 26.65 and (SD) - 2.78 years) was done on resting eyes closed and eyes open conditions. After EEG acquisition using 128 channel EEG machine, EEG was preprocessed and microstate analysis using CARTOOL software was performed on the EEG data. Results: After microstate analysis four maps topography were obtained. There was statistically non-significant difference observed in microstate maps between resting eyes closed and resting eyes open condition for the all parameters i.e. mean duration, time coverage and GEV. Conclusion: Our findings suggests that, both eyes closed and eyes open conditions were similar to each other in terms of stability and predominance of Maps

Knowledge, preventive behaviors, and risk perceptions of medical students toward COVID-19: A questionnaire-based original research study

Background: Coronavirus-19 (COVID-19) was identified as a cause of a disease outbreak in 2019 that originated in China. An infection without a cure makes the people, especially health care workers more vulnerable to get affected because of insufficient knowledge and unhealthy practices. Aim and Objective: This study aims to assess the knowledge and perceptions among medical students. Materials and Methods: A questionnaire-based cross-sectional study was conducted from December 2020 to February 2021 among the undergraduates and interns. The study was adapted from the current interim guidelines and information provided by Ministry Health and Family Welfare, Government of India (MOHFW, GOI) and Indian Council of Medical Research. Results: There were a total 355 participants. The majority (90.4%) of students had adequate knowledge. Only 9.5% had partial or no knowledge, the majority >90% of them showed a positive perception of COVID-19 prevention and control. In fact, majority 98.30% of students also got vaccinated against COVID-19. Conclusion: As there is no specific cure against COVID-19, it is essential to improve knowledge and belief among general public to prevent the spread. Medical students can, therefore, play a significant role by making community people aware about the seriousness of this pandemic.

Challenges Faced by People Affected with Leprosy During the COVID-19 Pandemic: A Questionnaire Based Study

This study aims to assess the continuity of medical care, the impact on disease condition and to highlight the major challenges faced by people affected by leprosy during the pandemic. Telephonic questionnaire-based survey was conducted among previously registered patients of leprosy at referral hospitals in India. Leprosy affected people aged >18 years, either on treatment or who had completed treatment with access to phone and willingness to participate were included. The questions were asked pertaining to demographic details, baseline disease characteristics and various problems faced during lockdown relating to livelihood, finances, treatment, and mental status. A total of 196 patients consented to participate in the study. Mean age of study participants was 37.31 (13.86) years, male participants (n=123, 62.7%) were more than females (n=73, 37.2%). Overall, 101 patients (51.5%) experienced exacerbation, 21 patients (10.7%) reported improvement and 74 patients (37.8%) reported no change in disease status during the pandemic. Most common difficulty faced was the procurement of medicines (115 patients, 58.6%) followed by difficulty in diagnostic testing (61 patients, 31.1%). Course of treatment was interrupted in 16 patients. Most of the patients (n=147, 75%), agreed that teleconsultation services would aid in management of their disease. The majority of patients (88.2%) were able to continue some form of treatment. Two patients (1%) tested positive for COVID-19. Nearly all patients (n=189, 96.4%) were informed regarding the risks and preventive measures related to COVID-19. Fifty percent of the patients reported deterioration in mental health due to the pandemic. The present study highlights the gaps in healthcare delivery and social inequalities along with their impact on the health, livelihood and mental status of people affected by leprosy during the current COVID-19 pandemic.

Impact of co-morbidities in COVID -19 infected patients

Background- During the COVID- 19 pandemic in the first wave, infected patients age was range from 4 weeks to 90 years and those who have more age and with comorbidities are more susceptible to develop serious illness and have high mortality rates. Objective-To study the association between survivor vs non survivor on the basis of demographic profile and high risk factors. Material & methods: This study was done in the Government Medical College, Kannauj on the COVID-19 patients who were admitted in the isolation wards, from 1st September 2020 to December 31st 2020. Statistical Analysis- Analysis was done using SPSS- 23 trial version software. Results: case fatality rate was 2.7% in this study. Most common symptoms was cough (61.0%) and among these admitted patients the most common comorbidities was hypertension (26.7%), followed by diabetes (20.7%), and COPD (14.0%) respectively. Platelets (< 0.02), post prandial blood sugar (PPBS) (< 0.01) have significant role in survivability of COVID- 19 patients. Conclusion: This study concludes that those patients who were older in age and with comorbidity especially (hypertension, COPD, high PPBS, High platelets) have poorer prognosis as compare to those without.

Knowledge of rural women regarding activities of accredited social health activist in three different villages of District Amritsar: A cross-sectional study

Background: Accredited Social Health Activist (ASHA) is the grass root level worker and hence plays a prime role in making primary healthcare accessible to rural areas. She creates awareness on health and persuading the community toward local health planning and hence plays major role in increasing utilization of health services. The knowledge of the people about the availability of ASHA in their area and about the activities performed by her also play important role in utilization of services given by ASHA. Hence, keeping this in view the present study was conducted. Aim and Objectives: (1) The aim of the study was to assess the knowledge of the rural women about the availability of ASHA in their area and (2) to assess the knowledge of the rural women about the activities performed by ASHA. Materials and Methods: The study was conducted in rural field practice area of Government Medical College, Amritsar, Punjab. The study was a cross-sectional type and the adult decision maker female of the family was interviewed using a pre-designed and semi-structured pro forma after approval from Institutional Ethics committee. A total of 1521 females were interviewed. Results: The present study revealed that majority (52.3%) of the respondents were in the age group of 24–45 years, 41.7% illiterate and 54.6% in the upper lower class. It was found that 45.8% respondents were visited by ASHA and out of these, majority of the respondents (78.2%) were visited for Maternal and child health services followed by health awareness (20.7%) and minor illnesses (9.9%). Conclusion: The visits by ASHA were irregular and majority of the respondents were visited by ASHA for maternal and child health services in all the three villages and hence knowledge regarding these activities was seen to be more among the respondents. However, overall less knowledge was seen among the villagers about other activities being performed by ASHA worker.

A comparative study of effects of surgical and natural menopause on menopausal symptoms and musculoskeletal complaints in menopausal women

Background: To decrease morbidity in patients undergoing hysterectomy for benign lesions, oophorectomy should not be done. Aims and Objectives: This study aims to compare the effects of surgical and natural menopause on menopausal symptoms and musculoskeletal complaints in menopausal women. Materials and Methods: This study was conducted in gynecology outpatient department from June 2019 to June 2020. A total of 200 postmenopausal women were selected between the age group of 40 and 55 years and then divided into two main groups – Group A (100), that is, natural menopause and Group B (100), that is, surgical menopause. Interviews were conducted about menopausal symptoms, using a standard questionnaire and were modified for yes or no response. The women were asked about symptoms such as hot flashes, sweating, vaginal dryness, dryness of skin, decreased libido, poor memory, depression, and musculoskeletal pain. Results: The study showed that menopausal symptoms and musculoskeletal pain were more common in women with surgical menopause as compared to women with natural menopause. The rate of hot flashes and sweating was more in surgical menopause group, that is, 81% and 82%, respectively, as compared to 52% and 50%, respectively, in natural menopause group. The musculoskeletal pain was more significant in Group B as compared to Group A, especially low back and upper back which were present in 55% and 42%, respectively, in Group B as compared to 43% and 41%, respectively, in Group A. Conclusion: As the menopausal symptoms and musculoskeletal pain are more common in patients with surgical menopause thereby increasing the morbidity, so oophorectomy should not be done in patients who are undergoing hysterectomy for benign lesions. Therefore, treatment of osteoporosis and hormone replacement therapy is recommended after surgery to decrease the menopausal and musculoskeletal symptoms within the 1st year of menopause.

Comparison of posterior optic capture of intraocular lens without vitrectomy vs endocapsular implantation with anterior vitrectomy in congenital cataract surgery: A randomized prospective study

Purpose: To compare surgical outcome of two procedures in pediatric cataract surgery. Methods: Prospective randomised interventional study. Consecutive patients with bilateral congenital cataract who were operated during January 2016 to October 2016 at a tertiary care referral institute were included. One eye of all patients underwent Intraocular lens (IOL) implantation with optic capture through a primary posterior continuous curvilinear capsulorhexis (PPC) without vitrectomy while in the other eye endocapsular IOL implantation was performed along with PPC and anterior vitrectomy. Intraoperative challenges and postoperative complications were noted. Results: 15/18 children who fulfilled the inclusion criteria were included for follow up analysis. Mean age at the time of surgery was 21 � 14.7 months. At a mean follow up of 25.69 � 1.06 months; all eyes in both groups maintained a clinically centred IOL with clear visual axis. One patient with endocapsular IOL implantation developed anterior capsular phimosis. The rate of fibrinous complications (IOL deposits and synechiae) were more in the eyes with IOL in the bag (6 eyes) vs eyes where posterior optic capture was done (1 eye); P = 0.039. Conclusion: Posterior optic capture is a safer alternative to conventional pediatric cataract surgery in terms of inflammatory sequelae and lens epithelial cell proliferation. However the two methods work equally well in preventing visual axis obscuration over a long follow-up.

Illicit drugs: Effects on eye

There is a myriad of changes that can be produced in the eye by toxic drugs ranging from mild/no symptoms to severe loss of vision from endophthalmitis. The routes of administration include oral ingestion, smoking, nasal inhalation, intravenous injection, topical application or application to other mucosal surfaces. It is important to recognize certain clinical signs and symptoms in the eye produced by these toxins. This article describes in brief some of the ocular effects of commonly abused drugs. For identification of a particular poisoning, in addition to the clinical presentation, pulse, blood pressure, respiration and body temperature, pupillary size, pupillary reaction to light, ocular convergence and nystagmus can be useful indicators of the type of drug the patient is exposed to. Unmasking these features help the clinician in an early and accurate diagnosis of the offending drug as well as timely management.

Silicone band loop myopexy for myopic strabismus fixus

Myopic strabismus fixus causes inability of the eye to elevate and abduct in the setting of a myopic superotemporally herniated globe. We report a novel surgical technique to manage an 18-year-old male with myopic strabismus fixus. Radiological imaging demonstrated a nasally deviated superior rectus (SR) and inferiorly displaced lateral rectus (LR). Silicone band assisted myopexy of SR and LR was done along with anchoring them to the sclera with a dacron suture. The patient had satisfactory alignment postoperatively and did not require any intervention over 1-year follow-up.

Detection of Extended-Spectrum Beta Lactamases and AmpC Beta Lactamases Producing Uropathogenic Escherichia coli in a Tertiary Care Hospital

Background: The multidrug resistant among uropathogenic E. coli has become a potential threat to global health. The aim of the current study to evaluate the antimicrobial activities of nitrofurantoin and fosfomycin along with other antimicrobials against Extended Spectrum β-Lactamases (ESBL) and AmpC producer isolates from the most common organism E. coli. Methods: A total of 6046 clean catch midstream urine samples were collected and processed in Microbiology department of tertiary care hospital. The antimicrobial susceptibility of E. coli isolates was initially screened by Kirby-Bauer disk diffusion method. The resistant isolates were confirmed to be ESBL and AmpC producers by their respective phenotypic confirmatory tests of combined disc method. Results: Out of 6046 patients there were 1855 E. coli positive patients. Maximum patients in the age group of 21-30 years were 51.5% followed by 31-40 years where patients were 26%. 64.4% E. coli were isolated from female patients and 35.6% from male patients. E. coli showed higher sensitivity towards, fosfomycin (100%), imipenem (100%), nitrofurantoin (84.1%), piperacillin and tazobactam (77.3%), amikacin (76.1%) and while they showed high degree resistance pattern against Penicillin, cotrimoxazole, ciprofloxacin, norfloxacin and 2nd and 3rd generation cephalosporin. Out of 1855 E. coli, multi drug resistance was seen in 520 E. coli isolates. ESBL production was observed among 50% of E. coli isolates by combined disk method. Out of 520 isolates, 150 isolates showed resistance to one or more extended-spectrum cephalosporins and cefoxitin by Kirby-Bauer disk diffusion method. These were selected and screened for ESBL and AmpC production. Among 150 cefoxitin-resistant isolates, AmpC phenotype was detected in 100 isolates (66.6%) by AmpC disc method. The overall occurrence of AmpC in the study was found to be 19.2%. Susceptibility of ESBL and AmpC producers to fosfomycin, imipenem, nitrofurantoin and amikacin were found to be 100%, 98.5%, 89% and 75% respectively. Conclusions: There is increased prevalence of ESBL and AmpC producing E. coli. Thus, early detection of ESBL and AmpC producer E. coli by simple phenotypic methods is necessary to avoid treatment failure, where molecular techniques are not available.

Detection of Extended-Spectrum Beta Lactamases and AmpC Beta Lactamases Producing Uropathogenic Escherichia coli in a Tertiary Care Hospital

Background: The multidrug resistant among uropathogenic E. coli has become a potential threat to global health. The aim of the current study to evaluate the antimicrobial activities of nitrofurantoin and fosfomycin along with other antimicrobials against Extended Spectrum β-Lactamases (ESBL) and AmpC producer isolates from the most common organism E. coli. Methods: A total of 6046 clean catch midstream urine samples were collected and processed in Microbiology department of tertiary care hospital. The antimicrobial susceptibility of E. coli isolates was initially screened by Kirby-Bauer disk diffusion method. The resistant isolates were confirmed to be ESBL and AmpC producers by their respective phenotypic confirmatory tests of combined disc method. Results: Out of 6046 patients there were 1855 E. coli positive patients. Maximum patients in the age group of 21-30 years were 51.5% followed by 31-40 years where patients were 26%. 64.4% E. coli were isolated from female patients and 35.6% from male patients. E. coli showed higher sensitivity towards, fosfomycin (100%), imipenem (100%), nitrofurantoin (84.1%), piperacillin and tazobactam (77.3%), amikacin (76.1%) and while they showed high degree resistance pattern against Penicillin, cotrimoxazole, ciprofloxacin, norfloxacin and 2nd and 3rd generation cephalosporin. Out of 1855 E. coli, multi drug resistance was seen in 520 E. coli isolates. ESBL production was observed among 50% of E. coli isolates by combined disk method. Out of 520 isolates, 150 isolates showed resistance to one or more extended-spectrum cephalosporins and cefoxitin by Kirby-Bauer disk diffusion method. These were selected and screened for ESBL and AmpC production. Among 150 cefoxitin-resistant isolates, AmpC phenotype was detected in 100 isolates (66.6%) by AmpC disc method. The overall occurrence of AmpC in the study was found to be 19.2%. Susceptibility of ESBL and AmpC producers to fosfomycin, imipenem, nitrofurantoin and amikacin were found to be 100%, 98.5%, 89% and 75% respectively. Conclusions: There is increased prevalence of ESBL and AmpC producing E. coli. Thus, early detection of ESBL and AmpC producer E. coli by simple phenotypic methods is necessary to avoid treatment failure, where molecular techniques are not available.

Safety and efficacy of 532 nm frequency-doubled Nd-YAG green laser photocoagulation for treatment of retinopathy of prematurity

Purpose: To evaluate the safety and efficacy of 532 nm frequency-doubled Nd-YAG green laser for treatment of retinopathy of prematurity (ROP). Methods: This retrospective interventional case series included infants undergoing treatment for ROP with 532 nm green laser between January 2012 and March 2017 at a single tertiary-care referral center. Review of clinical records was done to identify baseline ROP characteristics, procedural difficulties, complications related to the laser procedure and outcome of treatment at ? 1 year of follow-up. Results: There are about 347 eyes of 182 infants were included in this present study. ROP presented in zone I in 76 eyes (21.9%) and zone II in 271 eyes (78.1%). Tunica vasculosa lentis (TVL) was present in 43.8% and pre-existing vitreous hemorrhage in 4.6% of the eyes. 532 nm green laser could be performed as a primary procedure in all eyes, including those with TVL. 322 eyes completed a minimum follow up of 1 year with a mean follow up of 22.8 months (range, 12–54 months). At the last follow-up visit, 298 (92.5%) of the 322 eyes had a favorable outcome. On logistic regression analysis, pre-existing fibrovascular proliferation (p = 0.04) and new-onset fibrovascular proliferation after treatment (p = 0.001) were the most significant independent predictors of poor outcome. Complications encountered were new-onset hemorrhage in 36 eyes (11.2%), anterior segment ischemia in two eyes (0.006%) and cataract in one eye (0.003%). Conclusion: 532 nm frequency-doubled Nd-YAG green laser appears to be safe and effective in the treatment of ROP.

Analysis of heavy metals in water, sediment and selected fishes of River Sutlej, Punjab, India

Aim: The study aimed to assess the influence of heavy metal pollution in river Sutlej around the industrial city of Ludhiana. Methodology: Samples of water, sediment and commercially important selected fish species were collected before (S-1) and after (S-2) the confluence of Buddah Nallah in river Sutlej for the estimation of heavy matals using Atomic Absorption Mass Spectrometer, equipped with transverse graphite furnace tube for electro thermal determination of lead, copper, chromium and zinc. Results: he water, sediment and fish samples collected from the site, S-2 showed higher concentration of heavy metals compared site S-1. All the metals studied were found within the permissible limit of different National and International agencies, except for the lead which was found above the permissible limit in fish, Wallago attu. Interpretation: The results reveal that river Sutlej around Ludhiana city is under severe threat of pollution due to the discharge of industrial effluents from the Buddha Nallah

Estimation Of Bacoside-A In Bacopa Monnieri Aerial Parts Using Tlc Densitometry

Objective: The objective of the present work was to formulate and evaluate a stable, odour free garlic powder loaded floating matrix tablet for the treatment of peptic ulcers. Methods: A gastro-retentive floating matrix tablet (FMT) formulation of garlic powder (GP) was prepared using various concentrations of hydroxypropyl methylcellulose K4M (HPMC K4 M) and effervescent system (sodium bicarbonate and citric acid in 1:1 % w/w) to achieve desirable floating time (FT), floating lag time (FLT) and drug release. Wet granulation method was selected using ethanol as a binder for preparation of tablet. 32 full factorial designs were used for selection of suitable polymer concentration and effervescent system. Nonenteric film coating was applied to mask GP odour. Results: It was observed that FMT with optimum quantities of HPMC K4M and the effervescent system showed 97 % of drug release in 12 h with FT up to 10 h and minimum FLT of 3 min. There was no significant change in FLT, FT and drug content during the stability study of FMT. Conclusion: A stable, sustained release FMT of GP tablets using HPMC K4M and an effervescent system was successfully prepared. This formulation can overcome problems of taste and odour masking, gastric irritation, and loss of active constituents present in garlic.

Climate Predictions for Ludhiana District of Indian Punjab under RCP 4.5 and RCP 8.5

Climate change poses significant threats to global food security and water resources. In a present study, a Global Climate Model HAD GEM2-ES under RCPs 4.5 and 8.5 was used for climate prediction study. The study spanned 46 years of baseline (1970-2015) as well as two future periods’ mid-century (MC) (2020-2050) and end century EC (2060-2090). The results showed that the temperature would increase by 1.56°C and rainfall would decrease by 98 mm in MC (2020-2050); and 3.11°C and 90 mm in EC (2060-2090), respectively under RCP 4.5. In RCP 8.5 the increase in temperature and rainfall was 2.75°C and 153 mm, respectively in MC and the corresponding values in EC was 5.46°C and 251 mm, respectively.

Various Ways of Continuous Intraocular Pressure Monitoring in Glaucoma Patients: A Narrative Review

@#Glaukoma adalah sejenis penyakit neurodegeneratif yang berlaku akibat ketidakseimbangan dalam peredaran cecair akues yang disebabkan oleh resistan pada sistem pengaliran keluar cecair tersebut. Ini meningkatkan tekanan intraokular (TIO) yang menyebabkan kerosakan pada saraf optik dan seterusnya mengakibatkan kebutaan yang kekal. Oleh kerana TIO adalah satu faktor risiko glaukoma yang boleh dikawal, ciri-ciri dan variasi tekanan sepanjang 24 jam perlu dikenalpasti sebelum rawatan dimulakan. Pemantauan TIO adalah satu aspek yang terpenting dan kritikal dalam pengurusan glaukoma. Pelbagai tindakan kawalan melalui penggunaan teknologi yang berbeza telah dan sedang dilakukan untuk pemantauan TIO yang kerap dan berterusan selama 24 jam untuk menentukan kewujudan TIO yang tinggi (peak) dan fluktuasi tekanan. Artikel ini bertujuan untuk meninjau pendekatan inovatif yang terkini serta untuk mengulas kepentingan dan kelemahan setiap teknik bagi memperolehi profil TIO selama 24 jam.

A prospective randomized controlled study of Aurolab aqueous drainage implant versus Ahmed glaucoma valve in refractory glaucoma: A pilot study

Purpose: To study the efficacy of the Aurolab aqueous drainage implant (AADI) compared to Ahmed glaucoma valve (AGV) in patients with refractory glaucoma. Methods: This was a prospective, randomized controlled trial. Thirty-eight adult patients (>18 years) scheduled for a glaucoma drainage device (GDD) were randomized into two groups to receive either AGV or AADI. Primary outcome measures: intraocular pressure (IOP) control and requirement of antiglaucoma medications; secondary outcome measures: final best correct visual acuity (log MAR), visual field (Visual field index [VFI], mean deviation [MD] and pattern standard deviation [PSD]), postoperative complications and additional interventions. Complete success was defined as IOP ?5–?18 mmHg without antiglaucoma medications/laser/additional glaucoma surgery or any vision threatening complications. Results: There were 19 age and sex-matched patients in each group. Both groups had comparable IOP before surgery (P = 0.61). The AGV group had significantly lower IOP compared to AADI group (7.05 ± 4.22 mmHg vs 17.90 ± 10.32 mmHg, P = <0.001) at 1 week. The mean postoperative IOP at 6 months was not significantly different in the two groups (13.3 ± 4.2 and 11.4 ± 6.8 mmHg respectively; P = 0.48). At 6 months, complete success rate according to antiglaucoma medication criteria was 78.94% in AADI and 47.36% in AGV groups. AGV group required 1.83 times more number of topical medications than AADI group. There was no significant difference in early (P = 0.75) and late (P = 0.71) postoperative complications in the AADI and AGV group. The complete success rate was higher in AADI group (68.42%) than AGV group (26.31%) (P = 0.034). Conclusion: In this study, AADI appears to have comparable efficacy versus AGV implant with higher complete success rate at 6 months follow-up.