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Background and Objective Multidrug resistance is emerging worldwide at an alarming rate among a variety of bacterial species, causing both community-acquired and nosocomial infections, including Enterobacteriaceae. The clinical utility of carbapenems, the agents of last resort against multi-drug resistant Enterobacteriaceae, is under threat with the growing incidence of pan resistant isolates. This study aims to determine the prevalence of carbapenemase production among Enterobacteriaceae, as such data is not available from this area. Materials and Methods The study, prospective in design, was conducted during the period from April 2016 - August 2018. Any isolate reistant to IMP and/or MRP were subjected to phenotypic detection (Modified Hodge Test, MHT and Double Disk Synergy Test, DDST) and genotypic (blaIMP, blaKPC, blaVIM, blaOXA-48, blaOXA-23, blaOXA-51, blaOXA-58 and blaNDM) basis of carbapenamase production. Result: A total of 218 consecutive isolates of Enterobacteriaceae, which were resistant to IMP and/or MRP, were considered for the study. The most common isolates of Enterobacteriaceae were Klebsiella pneumoniae (n=122, 55.5%) followed by Escherichia coli (n=80, 36.4%). Modified Hodge Test (MHT) were positive for 12, 02 and Double Disc Synergy Test (DDST) were 11, 05 for Klebsiella and E.coli respectively. Multiplex PCR I and II, was performed for 36 isolates. The carbapenemase producing organisms were positive for 60% for single gene and 36% for multiple genes. Conclusion: Delay in detection of carbapenemase producing organisms result in longer hospitalization and increased health-care cost and this further affects the morbidity and mortality of patients in hospital set up.
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To gain insights on the diverse practice patterns and treatment pathways for prostate cancer (PC) in India, the Urological Cancer Foundation convened the first Indian survey to discuss all aspects of PC, with the objective of guiding clinicians on optimizing management in PC. A modified Delphi method was used, wherein a multidisciplinary panel of oncologists treating PC across India developed a questionnaire related to screening, diagnosis and management of early, locally advanced and metastatic PC and participated in a web朾ased survey (WBS) (n = 62). An expert committee meeting (CM) (n = 48, subset from WBS) reviewed the ambiguous questions for better comprehension and reanalyzed the evidence to establish a revote for specific questions. The threshold for strong agreement and agreement was ?90% and ?75% agreement, respectively. Sixty?two questions were answered in the WBS; in the CM 31 questions were revoted and 4 questions were added. The panelists selected answers based on their best opinion and closest to their practice strategy, not considering financial constraints and access challenges. Of the 66 questions, strong agreement was reached for 17 questions and agreement was achieved for 22 questions. There were heterogeneous responses for 27 questions indicative of variegated management approaches. This is one of the first Indian survey, documenting the diverse clinical practice patterns in the management of PC in India. It aims to provide guidance in the face of technological advances, resource constraints and sparse high?level evidence.
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Background: In view of recent publications of conflicting evidence on the safety and efficacy of hydroxychloroquine as prophylaxis and as a treatment for COVID-19 patients, we need to assess the effect of hydroxychloroquine in COVID-19 patients of authors own local population.Methods: In this retrospective chart review study, categorization of confirmed COVID-19 cases nasopharyngeal swab of RT-PCR was done into a group of patients who received hydroxychloroquine standard dose and another control group who did not receive hydroxychloroquine. The main comparing parameter was to see virus clearance days across both groups.Results: A total of 112 patients were included for the study, and grouped of 72 patient who received HCQS and remaining 40 patients as control. The virus clearance time in days was found to be 9.01±3.08 for HCQS group and for control group it was 8.64±2.34 days (Man Whitney U test value = 2.13, p=0.756).Conclusions: There is no significant difference found in attaining virus negative status with use of HCQS administration in this study.
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Introduction: The management of varicose veins haschanged rapidly in recent years. Conservative therapy istypically the first-line treatment for many patients withsymptomatic varicose veins. The present study was conductedfor retrospectively analyzing the profile of varicose vein andits management.Material and methods: A total of 100 patients within the agegroup of 15 to 65 years with varicose vein complications wereincluded. Complete demographic details of all the patientswere obtained from the data record files. Clinical details werealso obtained. A Performa was made and results of routineinvestigations were recorded. Details regarding the treatmentprotocol used (conservative, sclerotherapy, surgical) andfollow-up data was also recorded separately. Patients were notwilling and unfit for surgery and patients with complicationsaccording to data record files, were treated by conservativemanagement.Results: Dilated veins only were found to be present in 18percent of the patients while dilated veins with pain waspresent in 64 percent of the patients. Dilated veins withulcerations and dilated veins with bleeding were present in40 percent and 8 percent of the patients respectively. In 33patients undergoing Sclerotherapy, complete response wasseen in 17 patients, recurrence was seen in 6 patients whilethe remaining 10 patients did not come back on follow-up. In31 patients undergoing surgical therapy, complete resolutionat time of discharge was seen in 28 patients while residualvaricosities were seen in 3 patients.Conclusion: Varicose veins are a frequently encounteredpathology affecting the middle aged group with commonestpresentation being unilateral limb involvement. Hence agood clinical assessment with investigations is necessary forreducing the morbidity associated with it.
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Introduction: Chronic abdominal pain which is difficult to diagnose initially not only encumbers the patient but it also affectstheir daily routine, leading to physical and psychological disability, here comes the role of diagnostic laparoscopy which provesto be beneficial aiding in diagnosing most of these cases. Hence, the aim was to evaluate the diagnostic value of laparoscopyin cases with chronic abdominal pain.Materials and Methods: This study was done in the Department of General Surgery at Indira Gandhi Institute of Medicalsciences, Patna, Bihar, from July 2019 to March 2020 in 40 patients. Prior Institutional Ethical Committee approval was alsoobtained for this study.Results: Out of 40 patients included in this study, maximum number of patients were females. Male-to-female ratio was 1:1.4.The maximum number of patients were in the age group of 21–40 years (60%). Maximum patients 45% (n = 18) had complaintof pain in the right lower quadrant of abdomen. The most common finding during diagnostic laparoscopy was found to bepathology in the appendix accounting for 27.5% of cases (11/40).Conclusion: Diagnostic laparoscopy is a safe and effective tool to establish the etiology of chronic abdominal pain and allowsfor appropriate interventions. It can serve as a time saving and cost-effective implement for these patients.
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Background: Antibiotic policy and appropriate antibiotic prophylaxis cannot be designed unless data is available about bacteria colonizing the bile associated with gall bladder disease. Authors aim was to assess the clinical profile and pattern of bacterial isolates from bile aspirates of cholecystectomy patients seeking care at a tertiary care teaching hospital.Methods: Patients who underwent cholecystectomy for various hepatobiliary ailments during year 2017-18 formed the study population. Bile aspirates were collected during cholecystectomy and sent to the microbiology laboratory. Ultrasonography, computed tomography and MRCP were done to confirm the gall bladder pathology before surgery.Results: Out of total eighty-six patients, bacterial growth was observed in 28 (32.56%) subjects. As per division of bile samples, maximum number of study participants (39.29%) having bactibilia were seen in Group II. Group with second highest number of patients showing bactibilia was Group III with 9 subjects (32.14%). Eight subjects (28.57%) exhibited bacterial growth in bile aspirates in Group I subjects. Three patients (10.71%) showed bile infected with multiple bacteria i.e. polymicrobial infection. The gram-negative preponderance was seen in all the three groups with Escherichia coli being most common in group I and II. Pseudomonas aeruginosa was isolated in majority of the patients in group II and III.Conclusions: It is advised that all patients undergoing cholecystectomy must have their bile aspirated during cholecystectomy and sent for microbiological examination and culture. It will help in choosing appropriate antibiotic to prevent infection.
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Background: A good and an effective empirical treatment of SBP is not possible unless bacteriological spectrum and their antibiogram is clear. This becomes more important in country like India due to high antibiotic resistance. Authors aim was to assess the prevalence of SBP, clinical and microbiological profile of its variants, in patients with cirrhosis seeking care at a tertiary care teaching hospital.Methods: Patients of liver cirrhosis with ascites seeking care at study subject during January- December 2018 formed the study population. Diagnosis was based on clinical examination, biochemical investigation and ultrasonography. Diagnostic abdominal paracentesis was performed on subjects within 24 hours of admission. Ascitic fluid was aspirated. It was sent for microbiological examination.Results: Prevalence of SBP was 16.12%. Out of total ten subjects with Spontaneous Bacterial Peritonitis (SBP), six subjects were of Culture Negative Neutrocytic Ascites (CNNA). Thus most common (60%), variant of Spontaneous Bacterial Peritonitis (SBP) was Culture Negative Neutrocytic Ascites (CNNA). Prevalence of Mono-microbial Non-neutrocytic Bacterascites (MNBA) and Classic-Spontaneous Bacterial Peritonitis (C-SBP) was 20%. Two subjects found positive for MNBA, Staphylococcus aureus and Acinitobacter spp. was detected in each patient. Klebseila pneumonia, Escherichia coli and Coagulase negative Staphylococcus were found in ascitic fluid culture of C-SBP. In clinical variants of SBP, 80% subject’s complaint about abdominal pain. Hepatic-encephalopathy and fever was seen in 7(70%) patients. Rebound tenderness was seen among 60%.Conclusions: Diagnostic paracentesis should be advised to all cirrhotic patients with ascites. Ascitic fluid analysis should be sent for better selection of antibiotics thus better outcome of cirrhotic patients.
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Introduction: Diabetic foot syndrome (DFS) is one of the mostserious, important and economically demanding complicationsthat patients with diabetes can develop. Hence; the presentstudy was undertaken for assessing and comparing the serumHbA1C level among patients with and without diabetic footcomplication.Materials & Methods: A total of 150 diabetic patients wereenrolled in the present study. Clinical examination was done inall the patients and prevalence of diabetic foot complicationwas assessed. Blood samples were withdrawn from all thepatients and mean HbA1c concentrations were assessed usingautoanalyzer. All the values were recorded in Microsoft excelsheet and were analysed by SPSS software. Chi- square testwas used for assessment of level of significance.Results: Prevalence of diabetic foot complication was found tobe present in 30 patients. Mean HbA1C values of patients withdiabetic foot complications was 10.75%, while among thepatients without diabetic foot complication, it was 8.76%. Whilecorrelation of occurrence of diabetic foot complication withdiabetic profile, significant results were obtained.Conclusion: Patients with diabetic foot complications areaccompanied by significant alteration in mean HbA1c levels.
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Introduction: Hypertensive disorders in pregnancy are one ofthe leading causes of maternal and perinatal morbidity andmortality across the world. Hypoalbuminemia is not uncommonin women with the disease state whereas macroalbumiuria is apredictor of adverse pregnancy outcomes in the population.Hence; the present study was undertaken for assessmentserum albumin levels in pregnant hypertensive women.Materials & Methods: A total of 40 pregnant subjects wereanalysed. Among 40 subjects, 20 were hypertensive while theremaining 20 were non-hypertensive. Complete demographicdetails of all the patients were obtained. Blood samples wereobtained from all the patients and serum albumin levels wereassessed using autoanalyzer.Results: Mean age of the patients of the hypertensive andnon-hypertensive group was 59.6 years and 63.2 yearsrespectively. Mean serum albumin levels among the patients ofhypertensive and non-hypertensive group was 3.39 gm/dL and3.68 gm/dL respectively. Significant results were obtainedwhile comparing the mean serum albumin levels among thetwo study groups.Conclusion: Hypertensive pregnant subjects are accompaniedby significant alterations in serum albumin levels.
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Introduction: Present study was conducted to study the modes of injury in Subtrochanteric fractures of femur and to know the outcome of Proximal Femoral Nail in the treatment of Subtrochanteric fractures of femur. Material & Methods: A prospective observational study was conducted on a total of 30 cases of subtrochanteric fractures of femur. All patients were radiographed at an interval of 6 weeks after nailing, till evidence of union. The patient followed up for one year after the surgery at regular interval. Clinically, union of fracture was assessed and also examination for shortening and deformity was done. Functional outcome was assessed based on Modified Harris Hip Score. Results: Out of 30 cases, 24 cases gave history of road traffic accidents and 6 cases gave history of slip and fall. Full range of flexion of hip at 12 weeks post–operative was observed in 80% of cases and about 20% of patients showed minimally limited flexion. On a whole, all the patients had a satisfactory range of movements post operatively. Our study showed 80% of patients showed full range of movements and 20% showed minimally limited movements at 12 weeks post–operative. On a whole the range of knee movements was satisfactory. Conclusion: Proximal Femoral Nail is a relatively easy procedure and a biomechanically stable construct allows early weight beå. It offers the advantages of high rotational stability of the head–neck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking. Thus, the Proximal Femoral Nail is a suitable implant for treatment of all Subtrochanteric fractures
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Aims—We aimed to evaluate the prevalence of anemia among patients of Chronic Kidney disease, who are not requiring dialysis in a retrospective chart review. Methods— : It was a retrospective chart review study, all documents either as hard copy or electronically stored of diagnosed cases of CKD were assessed for inclusion – exclusion criteria, and on qualification their small Socio-demographic data sheet was filled up and available lab reports were recorded in tabulated form. Results— A total of 140 subjects were included for the study, 91 patients (65 %) were male and 35 % (n=49) were female. Based on blood hemoglobin estimation a total of 108 patients had anemia, which consisted of 77.1% of the total sample size. Conclusions— This study finds a prevalence of 77.1 % of anemia among CKD.
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We report a rare presentation of transitional cell carcinoma of kidney with paraneoplastic fever, leukemoid reaction and thrombocytosis. Description of the case highlights an unusual clinical scenario where fever, leucocytosis, pyuria and raised procalcitonin levels at presentation in a patient with transitional cell carcinoma of kidney may mislead diagnostic work up toward an infective cause (i.e. pyelonephritis). This case will guide clinician to keep a high index of suspicion, in case they encounter such a situation.
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Essential oils of different species of the genus Ocimum are natural flavouring materials of commercial importance. The data given in current literature are pertaining to the chemical composition of essential oils of different Ocimum species viz., Ocimum basilicum Linn. (alt. Ocimum basilicum var. minimum, Ocimum basilicum var. purpurience), Ocimum campechianum Mill., Ocimum canum Sims. (Ocimum americanum), Ocimum citriodorum, Ocimum gratissimum Linn., Ocimum kilimandscharicum Linn., Ocimum micranthum Willd., Ocimum sanctum Linn., (alt. Ocimum tenuiflorum Linn.), Ocimum selloi Benth., Ocimum trichodon, Ocimum utricifolium from different geographical regions. A considerable difference in chemical composition of a particular species is found, which may be due to their occurrence in different eco-climatic zones and changes in edaphic factors. Attention is also focused on the biological properties of Ocimum oils which are related to their various interesting applications as antimicrobial, antioxidant, repellent, insecticidal, larvicidal, nematicidal and therapeutic (anti-inflammatory, antinociceptive, antipyretic, antiulcer, analgesic, anthelmintic, anticarcinogenic, skin permeation enhancer, immunomodulatory, cardio-protective, antilipidemic) agents.
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Objective. To investigate the relationship between surfactant replacement therapy and the development of a haemodynamically significant ductus arteriosus. Methods. All premature infants at 28-32 wk gestation with a clinical diagnosis of respiratory distress syndrome were retrospectively reviewed and subdivided into two groups; intubated, mechanically ventilated and received surfactant (Group 1); and received nasal continuous positive airway pressure alone (Group 2). The relationship between groups and characteristics of the hemodynamically significant ductus arteriosus was analyzed. Results. Seventy babies were identified of whom 35 (50%) received surfactant. Babies in group I and II were comparable for gestational age, birthweight, antenatal steroids, gender and fluid intake in first week of life. Babies treated with surfactant therapy were found to be more likely to have a haemodynamically significant ductus arteriosus (p< 0.01), larger transductal diameter (p=0.01) and increased rate of therapeutic interventions to close the ductus (p<0.01). Ventilation parameters (mean airway pressure and fractional inspired oxygen) were higher in group I. Conclusion. Neonates with respiratory distress syndrome (RDS) who were treated with surfactant replacement are at increased risk of a hemodynamically significant ductus arteriosus that requires therapeutic intervention. Whether the relationship reflects their underlying lung disease or is a direct effect of surfactant requires prospective evaluation.