Isolation of Klebsiella pneumoniae and Acinetobacter radioresistens from Dish Wash Scrubbers

Aims: To identify predominant microorganisms in dish washing scrubbers collected from ten different sources. Study Design: Collection of dish wash scrubbers from different sources, pour plating of appropriately prepared dish wash scrub suspensions and subsequent isolation and identification of predominant isolates. Assessment of antibiotic susceptibility of the selected isolates by disc diffusion assay. Place and Duration of Study: April, 2018 - June 2018. Methodology: A total of 10 dish wash scrubbers (synthetic green scrubber pads free from any anti-bacterial preservatives belonging to the same brand) were collected from various sources. Appropriately prepared dish wash scrub suspensions in peptone water were pour plated on Plate Count Agar (PCA) and MacConkey agar. Predominant colonies selected from the plates based on the colony morphology were subjected to Grams staining, catalase, oxidase, indole, citrate, urease tests and genotypic identification by 16S ribosomal RNA sequencing. The identified isolates were tested for their susceptibility to eight antibiotics by disc diffusion method. Results: Irrespective of the sample source, most of the dish wash scrubbers sampled harbored similar types of colonies. From the colonies obtained two of them were identified by 16S rRNA sequencing and subsequent blasting as Klebsiella pneumoniae and Acinetobacter radioresistens. The isolates were deposited in the NCBI database with accession numbers MK032217 (Klebsiella pneumoniae RSV02) and MK032134 (Acinetobacter radioresistens RSV 01). These isolates were tested for their susceptibility to different antibiotics and Acinetobacter radioresistens RSV 01 was found to be more antibiotic susceptible than Klebsiella pneumoniae RSV02. Conclusion: Observations of this study confirm the potential role of dish wash scrubbers as vehicle for potential pathogens and their ability to act as cross contaminating agents in food processing environments.

Studies on Hepatoprotective Activity of Various Extracts of Macaranga peltata (Roxb.) on Paracetamol-Induced Hepatotoxicity Rats.

Liver disease is universal problem. In the absence of reliable liver-protective drugs in allopathic medical practices, herbal products take a role in the management of various liver diseases. Current investigation was to examine hepatoprotective potential of Macaranga peltata (Family Euphorbiaceae) on paracetamol-induced hepatotoxicity in rats.METHODSThe aerial parts of Macaranga peltata dry powder was extracted with various solvents (PE, EA and methanol) through Soxhlet extractor and crude extract was utilized testing of hepatoprotective activity. Paracetamol (2 g/Kg b. wt.) given orally to rats induced hepatotoxicity on the 5th day of the investigational period.RESULTSRats with paracetamol-induced hepatotoxicity exhibited elevated (p<0.001) activities of liver enzymes [SGOT, SGPT, ALP, gamma-glutamyl transpeptidase (GGT)], creatinine, urea, total bilirubin, total cholesterol & TG and reduced total protein in serum. Furthermore, rats which were given oral methanolic concentrates of Macaranga peltata (200 mg/Kg b. wt.) showed major reduction in the level of SGOT, SGPT, ALP, gamma-glutamyl transpeptidase (GGT) creatinine, urea, total bilirubin, total cholesterol & triglycerides and also significantly elevated the concentration of total protein and albumin when compared to other concentrates.CONCLUSIONThus, results suggest that methanolic concentrates of Macaranga peltata could afford better hepatoprotective activity against paracetamol induced hepatotoxicity in rats.

The tobacco trade and trail in Karnataka

BACKGROUND: Tobacco is a growing epidemic and tobacco-related death results in health consequences and lost economic opportunities. Tobacco cessation efforts mandate the use of multiple strategies to bring about behaviour change. AIM: To develop and validate health promotive text messages using transtheoretical model and prospect theory for behaviour change. SETTINGS AND DESIGN: The present observational study was conducted in a tertiary care hospital, Delhi among patients reporting at Tobacco Cessation Centre (TCC). METHODS: The study was divided into two phases: first involved development of text messages in local language (Hindi) using a sound theoretical basis (TTM and prospect theory) and second phase dealt with validation of the developed text messages by patients and experts in the field of tobacco cessation. STATISTICAL ANALYSIS: Descriptive statistics was obtained using the SPSS version 17. RESULTS: The sample comprised 20 males and 6 females. Average appeal score ranged from 6.1 to 9.6 (54 messages). Forty two messages out of a total of 54 messages were found to be appropriate after validation by the experts. Mean words of the final messages (42 messages) was 24.5 ± 1.3. Two hundred ninety one (90%) out of a total of 324 questionnaires showed adequate understanding of message as assessed by the reviewers. CONCLUSIONS: The current effort developed and validated health promotive text messages package to aid in tobacco cessation. The preventive text messages were grounded in evidence and sound theoretical basis and followed a standard validating procedure leading to satisfactory understanding and appeal in all domains

Role of Therapeutic endoscopy vs surgery in the management of traumatic pancreatic injury – A tertiary referral center experience

Background: Pancreatic injury remains a complicated condition requiring an individualized case by case approach to management. In this study, we aim to analyze the varied presentations and treatment outcomes of traumatic pancreatic injury in a tertiary care center. Materials and methods: All consecutive patients hospitalized at our center with traumatic pancreatic injury between 2013 and 2017 were included. The American Association for Surgery of Trauma (AAST) classification was used to stratify patients into five grades of severity. Outcome parameters were then analyzed based on the treatment modality employed. Results: Of the 35 patients analyzed, 26 had an underlying blunt trauma with the remaining 9 presenting due to penetrating injury. Overall in-hospital mortality was 28%. 19 of these patients underwent exploratory laparotomy with the remaining 16 managed non-operatively. 9 patients had severe injury (>grade 3) – of which 4 underwent endotherapy, 3 had stents placed and one underwent an endoscopic pseudocyst drainage. Among those managed non-operatively, 3 underwent a radiological drainage procedure. Conclusion: Mortality rates were clearly higher in patients managed operatively. This is likely a result of significantly higher degrees of major associated non-pancreatic injuries and not just a reflection of surgical morbidity. Despite this, surgical management remains the mainstay of therapy, especially in higher grades of pancreatic injury. However we would like to emphasize that endoscopic intervention definitely remains the preferred treatment modality when the clinical setting permits. This is especially applicable in cases of main pancreatic duct injury with ascites as well as pseudocysts.

Utility of pulmonary venous flow diastolic deceleration time in an adult patient undergoing surgical closure of atrial septal defect and coronary artery bypass grafting.

Acute left ventricular (LV) failure has been reported after surgical closure of atrial septal defect (ASD) in adult patients. We report acute LV failure in a 56 year old gentleman following coronary artery bypass grafting (CABG) and surgical closure of ASD. Transesophageal echocardiography examination of the patient following closure of ASD and CABG showed a residual ASD and a shunt (Qp :Qs = 1.5). The residual ASD was closed after re-institution of cardiopulmonary bypass (CPB) under cardioplegic cardiac arrest. However, the patient did not tolerate closure of the residual ASD. The CPB was re-established and under cardioplegic cardiac arrest residual ASD was reopened to create a fenestration. This time patient was weaned easily from CPB. Postoperatively, 16 hours after extubation, patient became hemodynamically unstable, the patient was electively put on ventilator and intra-aortic balloon pump. Later the patient was weaned off successfully from ventilator. Retrospective analysis of pulmonary venous flow diastolic deceleration time (PVDT D ) recorded during prebypass period measured 102 msec suggestive of high left atrial pressure which indicate possibility of LV failure after ASD closure.

Pre-operative short-term pulmonary rehabilitation for patients of chronic obstructive pulmonary disease undergoing coronary artery bypass graft surgery.

The role of pre-operative short-term pulmonary rehabilitation in patients with chronic obstructive pulmonary disease who undergo coronary artery bypass graft surgery has been assessed for the first time prospectively. Forty-five patients posted for coronary artery bypass graft surgery were randomised to receive either short-term pulmonary rehabilitation (group I) or no such programme (group II). Patients of both the groups were evenly matched with respect to age, sex, body surface area, duration and severity of chronic obstructive pulmonary disease and coronary artery disease. Normal individuals who evenly matched with the study group were assessed for normal respiratory function parameters. Pre-operative and post-operative peak expiratory flow rate, inspiratory capacity, post-operative ventilation time, post-operative pulmonary complication and hospital stay were determined in both the groups. Peak expiratory flow rate (220.0 +/- 12.9 and 324.3 +/- 84.3 in group I, 218.0 +/- 16.4 and 260.5 +/- 35.2 in group II) and inspiratory capacity (844.0 +/- 147.4 and 1100.0 +/- 158.1 in group I, 830.0 +/- 117.4 and 1090 +/- 137 in group II) were significantly lower before and after surgery respectively in both groups compared to normal values. Even though both groups showed a significant rise in post-operative peak expiratory flow rate and inspiratory capacity after surgery, the post-operative peak expiratory flow rate and inspiratory capacity in group I was significantly higher than in group II. In group I, the post-operative ventilation time (24.5 +/- 6.00 hours), post-operative complications (n = 4) and hospital stay (12.4 +/- 3.6 days) were significantly lower than in group II (35.2 +/- 22.3 hours, n = 11, 18.8 +/- 6.6 days respectively). These data suggest that short-term pulmonary rehabilitation is feasible and effective in improving pulmonary functions before and after surgery and in reducing surgical morbidity and cost of medical care significantly.

Systemic lupus erythematosus in Indian patients: prognosis, survival and life expectancy.

BACKGROUND: There have been several studies on survival patterns in Indian patients with systemic lupus erythematosus but it is still not clear as to which factors at diagnosis predict survival outcome. The impact of specific organ involvement, and of disease activity itself, needs to be studied further. METHODS: We conducted a non-concurrent prospective study of 98 lupus patients between 1981 and 1993. The clinical symptoms, signs and investigation results at onset, and at subsequent visits, were abstracted from the case notes. A systemic lupus erythematosus disease activity index (SLEDAI) was constructed at the initial presentation and for each subsequent visit. Patients not attending for at least 6 months were traced by post. The quantitative data from the SLEDAI was used to construct a Markov chain mathematical expression designed to predict life expectancy. RESULTS: The cumulative percentage survival at 1, 5 and 10 years was found to be 89%, 77% and 60%, respectively. The Markov chain predicted a life expectancy of 13.9 years. Central nervous system and renal involvement were poor prognostic factors. Proteinuria (> 0.5 g/day) caused a 50% reduction in life expectancy but increased disease activity at onset did not predispose to a poor outcome. CONCLUSION: The survival of patients with systemic lupus erythematosus continues to be poor. Central nervous system and renal disease indicate a poor outcome. Hence, new treatment strategies must be evolved to improve the survival of such patients.