ABSTRACT
Background: Multidrug-resistant (MDR) colonisers act as a reservoir for transmission of antibiotic resistance and are a source of infection. Exposure to antibiotics by the commensal flora renders them resistant. Antibiotic consumption and hospitalisation are two major factors influencing this. We studied, antibiotic-resistant bacteria colonising rural adult population who had restricted access to health care and presumably had low consumption of antibiotics. Aim: Detection of multidrug resistance genes of extended spectrum ?-lactamase (ESBL-CTX-M), AmpC ?-Lactamase (CIT), Klebsiella pneumoniae carbapenemase (KPC) and New Delhi Metallo ?-lactamase (NDM) in Enterobacteriaceae colonising the gut of adult population in a South Indian rural community. Methodology: Faecal samples of 154 healthy volunteers were screened for Enterobacteriaceae resistant to commonly used antibiotics by standard methods, followed by phenotypic detection of ESBL by double disk synergy method, AmpC by spot inoculation and carbapenemases by imipenem and ethylenediaminetetraacetic acid + imipenem combined E-test strips and modified Hodge test. Polymerase chain reaction was done to detect blaCTX-M,blaCIT,blaKPC-1 and blaNDM-1 genes coding for ESBL, AmpC, KPC and NDM, respectively. Results: Colonisation rate of enteric bacteria with MDR genes in the community was 30.1%. However, phenotypically, only ESBL (3.2%) and NDM (0.65%) were detected. While the genes coding for ESBL, AmpC and NDM were detected in 35.6%, 17.8% and 4.4% of the MDR isolates, respectively. Conclusions: Carriage of MDR strains with a potential to express multidrug resistance poses a threat of dissemination in the community. Awareness for restricted use of antibiotics and proper sanitation can contain the spread of resistant bacteria.
ABSTRACT
Data on aerobic fitness and heart rate recovery in children are limited. This study was done to evaluate the relation between them in Indian school going children. Three hundred children of 7 to 10.5 years were recruited and their aerobic fitness was predicted using modified Harvard’s step test (VO2max) and 20 meter shuttle test (VO2peak). The heart rate was monitored for 12 minutes post modified Harvard’s step test. The difference between the maximum and the 1st minute HR was noted as HRR1 and the time taken to reach the resting heart rate was also recorded. VO2max was inversely correlated with HRR1 (r = –0.64, p<0.001). However, the partial correlation of the two was not significant (rpartial = –0.037, p=0.55), indicating children with higher basal HR had higher HRR1 and that accounted for the observed association with aerobic fitness. Cox regression analysis showed that the recovery rate per unit time was 3% greater with increasing VO2max (HR=1.03, 95% CI:1.01 to 1.05, p=0.013). The heart rate parameters did not show any associat with VO2peak. This study demonstrates that there is no relation between VO2max and HRR1 after 3 minutes of modified Harvard’s step test in Indian children of 7 to 10.5 years. However, aerobic fitness is a positive predictor of heart rate recovery time in this group.
ABSTRACT
Breast cancer is the most frequent tumor among Saudi women, accounting to 19.8% of female cancers. The present study was conducted to determine 5-year survival for all cases of invasive breast cancer that occurred during 1994-96 in the province of Riyadh (n=316). The overall observed survival probability of the study population at 1, 3 and 5 years was 93.9%, 79.2% and 59.6%, respectively. The 5 year survivals for the younger (< 40 years), older (50 + years) and 40-49 years patients were 60.6%, 51.6% and 69.2% respectively, the differences not reaching statistical significance. While there was not a great deal of variation in the 5-year survival between cases with regional (55.6%), distant metastasis (57.6%) and extent of disease unknown (56.7%) cases, localized (67.5%) cases had a clearly better prognosis. An increased but not significant hazard was seen for the cases with regional and distant metastasis disease, 1.40 and 1.11 respectively, compared to localized cases. The 5-year survival for duct carcinomas (62.8%) was greater than for adenocarcinomas (55.6%) and lobular carcinomas (50.0%).
Subject(s)
Adult , Breast Neoplasms/mortality , Female , Humans , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Prognosis , Proportional Hazards Models , Risk Factors , Saudi Arabia/epidemiology , Survival AnalysisABSTRACT
Cancer of the uterine cervix is one of the leading causes of cancer death among women worldwide. The estimated new cancer cervix cases per year is 500,000 of which 79% occur in the developing countries. Cancer cervix occupies either the top rank or second among cancers in women in the developing countries, whereas in the affluent countries cancer cervix does not even find a place in the top 5 leading cancers in women. The truncated rate (TR) in the age group 35-64 years in Chennai, India, is even higher (99.1/100,000; 1982-95) than rate reported from Cali, Colombia (77.4/100,000, 1987-91). The cervical cancer burden in India alone is estimated as 100,000 in 2001 AD. The differential pattern of cervical cancer and the wide variation in incidence are possibly related to environmental differences. Aetiologic association and possible risk factors for cervical carcinoma have been extensively studied. The factors are: Sexual and reproductive factors, socio-economic factors (education and income), viruses e.g., herpes simplex virus (HSV), human papillomavirus (HPV), human immunodeficiency virus (HIV) in cervical carcinogenesis and other factors like smoking, diet, oral contraceptives, hormones, etc. The accumulated evidence suggests that cervical cancer is preventable and is highly suitable for primary prevention. Sexual hygiene, use of barrier contraceptives and ritual circumcision can undoubtedly reduce cervical cancer incidence. Education, cervical cancer screening of high risk groups and improvement in socio-economic status can reduce cervical cancer morbidity and mortality significantly.