Differential diagnosis of non-small cell lung carcinoma by circulating microRNA

Introduction: More than 70% of lung cancer comprises nonsmall-cell lung carcinoma and is associated with poor survival outcome owing to late diagnosis. Identification of lung cancer in early stages when no clinical signs or symptoms are evident, can drastically improve the prognosis. To this end, we aimed to evaluate the changes occurring at tissue level by assessing the expression of six microRNAs (miRNAs) in lung adenocarcinoma (AC) and squamous cell carcinoma (SCC). Materials and Methods: Peripheral blood of histopathologically proven cases of lung AC and SCC was collected and processed for the isolation of miRNAs using commercially available kit. Primers against mir-2114, mir-2115, mir-2116, mir-2117, mir-449c, and mir-548q with loading control Caenorhabditis elegans were used. Screening was carried out in thirty cases of both AC and SCC, whereas twenty healthy controls were included. Results:Real-time polymerase chain reaction data revealed that the expression of mir-2114 and mir-449c in AC and mir-2115 in SCC was significantly upregulated. The expression of these miRNAs was also confirmed in lung AC cell line. The differential pattern of expression of these miRNAs can be used for precise diagnosis of lung carcinoma Conclusions: We have used a noninvasive technique to identify the subtype of lung cancer based on molecular genetic signatures. The results suggest that through molecular profiling of miRNA, we can screen high-risk cases for cancer interception

Patient-doctor ratio across nine super speciality clinics in government hospital: a cross sectional study

Background: There is lack of information regarding patient-doctor ratio in government hospitals in India. The aim of the present study was to measure patient-doctor ratio across nine super specialty clinics. The objectives were to measure Outpatient department (OPD) patient-faculty and patient-senior resident doctor ratio, to measure number of patients seen per unit time and time spent per patient in OPDs across nine super specialty clinics.Methods: Total number of OPD patient visits in year 2018 was retrieved for cardiology, gastroenterology, gastrointestinal surgery, neurology, neurosurgery, nephrology, urology, paediatric surgery and oncology. Number of faculties and senior residents working in above specialties were obtained. Ratio of OPD patients to faculties and senior residents across nine above clinics were derived and compared. The average time spend per patient in OPDs across nine above clinics was calculated by number of working days in year 2018 and number of working hours or day in OPD clinics, excluding public holidays.Results: Total 3,59,099 OPD patient visits were registered in year 2018 across nine super specialty clinics. Patient to faculty ratio was highest for gastroenterology followed by neurology and cardiology, while least for neurosurgery and paediatric surgery in descending order. Gastroenterology, neurology and oncology OPDs saw more than 200 patients per working day; with average time spend per patient consultation was two minutes. Compared to super specialty physicians who spend average of 2.2 minutes per patient consult, surgical disciplines used an average of ten minutes per patient for consultation.Conclusions:Super specialty clinics in government hospitals are over worked and under staffed with heavy patient load. Multiple parallel clinics in concerned specialty will provide more time and quality of services per patient.

Impact of Chhath festival on health seeking behaviour of local population

Background: There is lack of information regarding health seeking behaviour of local population during Chhath puja. The aim is to evaluate health seeking behaviour of local population during Chhath festival. And the main objectives is to evaluate the extent of change of routine visits of people seeking healthcare during Chhath festival across major super speciality departments of government hospital.Methods: Database of outpatient department visits across nine super specialities namely, cardiology, gastroenterology, gastrointestinal surgery, neurology, neurosurgery, nephrology, urology, paediatric surgery and oncology were obtained for year 2016, 2017 and 2018 from hospital records. Median and maximum number of outpatient visits per month of each of the nine specialities per year was compared with number of outpatient visits during Chhath festival month of corresponding year.Results: In year 2018, there was 18% average absolute decline of outpatient visit during Chhath month compared to median number of outpatient visits per month that year. Similarly, the average absolute decline of OPD visits was 32% during Chhath month compared to the month when there was maximum number of outpatient visits in 2018. Cardiology, gastroenterology, neurology, nephrology and oncology had more than 20% absolute decline in 2018 compared to median. Trends was similar in year 2017 and 2016, with average decline in Chhath month compared to median and maximum outpatient visits in corresponding year as 3%, 14%, 10% and 26% respectively.Conclusions: Health seeking behaviour of local population drops by one fifth during Chhath festival. Fall in outpatient visits is consistent, uniform and recurring every year.

Epidemiological Correlates and Treatment Outcomes among Patients with MDR Tuberculosis in Northern India

Introduction: Multi drug resistant-TB (MDR-TB) threatens global TB control and is a major public health concern in several countries. The present study was undertaken to detect the epidemiological correlates and treatment outcomes among patients with MDR-TB previously or currently admitted in Department of Respiratory Medicine and Pulmonary and Critical Medicine, KGMU, Lucknow. Material & Methods: This retrospective study included 2370 TB patients admitted in the Department of Respiratory Medicine and Pulmonary and Critical Medicine, KGMU, Lucknow between years 2012 to 2015. Treatment outcomes were observed. SPSS software was used for data analysis. Results: The total number of MDR-TB cases enrolled were 2370. There were 772 (32.6%) males (95% CI: 30.7 % -34.5%) and 1598 (67.4%) females (95% CI: 65.5% -69.3%) registered for MDR-TB treatment. The treatment outcomes were as follows: majority (77.1%) were under treatment, 279 (11.8%) patients were declared cured, 10 (0.4%) were failure cases, while 64 (2.7%) were defaulters, 149 (6.3%) had died and 41(1.7%) were transferred out. Conclusion: Emergence of MDR-TB has the potential to be a serious public health problem in Northern India and this necessitates strengthening of TB control and improved continuous monitoring of therapy.

Emergence of staphylococcal cassette chromosome mec type Ⅰ with high-level mupirocin resistance among methicillin-resistant Staphylococcus aureus

Objective: To investigate the molecular epidemiology and antimicrobial resistance patterns of methicillin-resistant Staphylococcus aureus (MRSA) among healthcare workers and patients. Methods: MRSA isolates were recovered from nasal swabs collected at a tertiary care hospital of Nepal and confirmed on the basis of Gram staining, conventional biochemical tests, and PCR amplification of mecA gene. PCRs were also used for detection of the different resistance genes and staphylococcal cassette chromosome (SCC) mec types. Antibiotic susceptibility patterns of isolates were assessed by disc diffusion method and minimum inhibitory concentrations were determined by E-test. Results: A total of 29 MRSA were isolated from 536 nasal swabs (5.4%) of health care workers and patients at a tertiary care hospital in Nepal. All isolates were susceptible to amikacin, gentamicin, vancomycin (minimal inhibitory concentrations1024μg/mL). Fourteen isolates were found harboring the mupA gene and one isolate was found carrying the novel mupB gene. High prevalence (68%) of SCCmec I type was found, followed by SCCmec V (13%) and SCCmec III (3%) among all the MRSA isolates. Conclusions: We found the emergence of SCCmec type Ⅰ with high-level mupirocin resistance among MRSA in Nepal. Data also suggest that MRSA SCCmec type V strain has spread from the community to the hospital.

Intestinal parasitosis among the elderly people in Kathmandu Valley.

Present study was carried out among the elderly people (60+ years of age) from August 2005 to July 2006 in Kathmandu Valley to assess the prevalence of intestinal parasitosis in them. Stool samples were collected from 235 elderly people (122 from government elderly home, 66 from private elderly home and 47 from the households in a rural community). The samples were examined by formal ether sedimentation and Sheather's sucrose floatation followed by Kinyoun's modified Ziehl-Neelsen staining. The overall prevalence of intestinal parasites was found to be 41.7%, out of which 30.6% had multiple parasitism. The government elderly home had significantly higher parasitic prevalence (50.8%) followed by the rural community (46.8%) and the private elderly homes (21.2%) (P<0.05). Males (43.8%) had slightly infection rate than females (40.4%) (P>0.05). There was equal infection rate with protozoa (25.8%) and helminths (27.0%). Trichuris trichiura (39.4%) and Entamoeba histolytica (19.7%) were the commonest helminth and protozoa, respectively.

Microbial study of hospital environment and carrier pattern study among staff in Nepal Medical College Teaching Hospital.

The present study was done to see the microbial flora in the environment (air and surface) of Nepal Medical College Teaching Hospital and the staffs working in the hospital. Altogether 160 environmental (air n = 43, surface n = 117) samples were collected and studied from different wards. Similarly 150 samples (48 nasal swabs, 48 throat swabs and 54 hand samples) from the staffs were collected and studied following the standard microbiological protocols. Gram +ve cocci were the most predominant ones among the bacterial isolates from the environment followed by gram +ve bacilli and gram -ve bacilli. Among fungal isolates, yeast were the most common isolates while Aspergillus spp. were the most frequently occurring mold. Out of 150 samples collected for the study of carrier pattern, 32 out of 54 samples collected were found to have Staphylococcus aureus in their hands, 1 had Escherichia coli. Other isolates were Bacillus spp., Micrococci and coagulase negative staphylococci. Similarly 21 (43.8%) out of 48 nasal samples were found to have S. aureus while none of the staffs were found to have beta-hemolytic streptococci in their throat. In the study, 1.6% environmental isolates and 5.7% carrier isolates of S. aureus were found to be Methicillin resistant.

Intestinal parasitic infections among HIV seropositive and high risk group subjects for HIV infection in Nepal.

Present study was carried out to find out the prevalence of intestinal parasites in HIV seropositive (HIV+) subjects and high risk group (HRG) for HIV infection in Nepal. A total 196 (HIV+: n = 112; Age: 16-52 years and HRG: n = 84; Age: 16-39 years) individuals were included. Stool specimens were examined by direct smear, formal-ether sedimentation, Sheather's sucrose floatation and Kinoyun modified Ziehl-Neelsen methods. Overall prevalence of intestinal parasites was 35.7% (70/196) (26.7% in HIV+ subjects and 47.6% in HRG subjects). Trichuris trichiura was the commonest parasite in HIV+ subjects (50.0%), whereas hookworm was most common among HRG subjects (56.8%). There was an association of parasitic infections with the gastrointestinal tract symptoms in both the study subjects. Tibeto-Burmans study subjects had marginally higher prevalence than Indo-Aryans study subjects (P > 0.05). Multiparasitic infections were relatively more common among HIV+ subjects (7.2%) in comparison to HRG subjects (4.8%). Similarly the protozoan infections were relatively higher in HIV+ subjects (4.5%) compared with HRG subjects (1.2%). The opportunistic protozoa Cryptosporidium parvum was detected only in 5.2% HIV+ subjects.