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Introduction: Carbapenem resistance due to metallo-beta-lactamase (MBL)-producing bacteria is an emerging threat worldwide. This study aimed to detect the MBL production in clinical isolates of E. coli and Klebsiella pneumoniae species in our hospital setting and to evaluate the efficiency of two phenotypic methods for the detection of MBL production. Materials and Methods: The present study was carried out in the Department of Microbiology, MGM Medical College and Hospital, Aurangabad, Maharashtra, for a period of 2 years from April 2018 to March 2020. From a total of 12,324 various clinical specimens, 393 isolates of E. coli and Klebsiella pneumoniae species were tested for MBL production. MBL was detected by two different phenotypic methods, i.e., combined disc test and E-test. Results: Out of 393 isolates, 130 (33.07%) isolates were resistant to imipenem on screening of which 71 (18.06%) were Klebsiella pneumoniae and 59 (15.01%) were E. coli. About 43.66% Klebsiella pneumoniae isolates and 40.67% E. coli isolates were MBL-positive by the combined disc test. Using the E-test, MBL production was found to be 46.47% and 45.76% in Klebsiella pneumoniae and E. coli, respectively. Conclusion: Routine screening of MBL-producing organisms should be performed in diagnostic laboratories to control the spread of resistance and for the proper management of antibiotic therapy. E-test is better than the combined disc test for the detection of MBL-producing gram-negative bacilli.
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Background: To conduct a prospective observational study to compare the haemodynamic changes in two age groups, group A: 60-75yrs and group B: >75yrs during cemented bipolar hemiarthroplasty for hip fractures under spinal anaesthesia.Methods: Patients of either sex belonging to above two groups, with no contra-indications for central neuraxial block received spinal anesthesia at lumbar level. Heart Rate (HR), Systolic Blood Pressure(SBP), Diastolic Blood Pressure(DBP) and Mean Arterial Pressure(MAP), pulse pressure variability(PPV), arterial oxygen saturation (SpO2), Electrocardiogram for any changes and nasal end tidal CO2 (EtCO2) were recorded at the following time points: baseline(on table), after giving spinal, after giving surgical position, at the start of surgery, at femoral canal reaming, immediately after cement insertion, every 2 minutes after cement insertion, femoral joint reduction and the end of the surgery. Hypotension, bradycardia, arrythmias, desaturation or unexpected loss of consciousness occurring in peri-cementation period suggestive of ‘Bone cement implantation syndrome’(BCIS) or any other adverse event was recognized and treated.Results: The SBP, HR, PPV, ETCO2, SPO2 and incidence of adverse events; were comparable in both the groups. The difference in the DBP and MAP was statistically significant.Conclusions: The difference in the occurrence of haemodynamic alterations was more in the older age group. Continuous vigilant monitoring during bipolar hemiarthroplasty is required.
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Background: Extended Spectrum Beta Lactamases(ESBLs) are rapidly evolving group of β-lactamaseenzymes that are of particular concern to clinicians andepidemiologists. Most ESBLs have been evolved bygenetic mutation from blaTEM and blaSHV genes, andare well described in Klebsiella pneumoniae. Aim andObjective: To investigate the ESBL genotypes in K.pneumoniae isolates from Respiratory Tract Infections(RTIs). Material and Methods: Clinical isolates of K.pneumoniae were obtained from RTI -sputum samples.Antimicrobial susceptibility was determined by KirbyBauer disc diffusion method. ESBL was detectedphenotypically and multiplex Polymerase ChainReaction (PCR) specific for blaTEM, blaSHV andblaCTX-M genes was performed to identify genotypes.Results: During the 19 months period, a total of 212 ofK. pneumoniae were found from RTIs. Of these 212isolates, 60 isolates (28.3%) were ESBL producers byphenotypic method. Of these 212 isolates, 96 wererandomly selected for multiplex PCR for blaTEM,blaSHV and blaCTX-M genes. The findings ofmultiplex PCR showed that 24 isolates (25%)possessed blaTEM gene and only 4 isolates (4.1%)possessed each blaSHV and blaCTX-M gene alone.Isolates having both blaTEM+blaSHV genes were 20(20.8%), and both blaTEM+blaCTX-M genes were 12(12.5%); and isolate possessing all threeblaTEM+blaSHV+blaCTX-M genes were 20 (20.8%).The overall prevalence of blaTEM, blaSHV andblaCTX-M genes in this study was 79.1%, 45.8% and37.5% respectively. Imipenem was most effectiveantibiotic. Conclusion: Spread of ESBL producing K.pneumoniae is a major concern, as it causes limitationsto optimal treatment. Multiplex PCR can be used as arapid method to identify ESBL genotypes in K.pneumoniae. It will prove valuable for surveillance andestablishing the treatment line against drug resistantorganisms, thus saving precious time and resources. Inour study blaTEM genotype was most prevalent.
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Introduction: The concepts taught in pre-clinical sciences serve as a backbone to understand the clinical sciences. The system of teaching basic science subjects through didactic lectures followed in most of the medical colleges is more of a teacher centered. The medical educators are concerned about the learning outcomes of the traditional programs of teaching. Usually feedback on curriculum is obtained by subject experts from other universities. There is an unmet need to obtain the perceptions of graduates as they represent one of the important stakeholders of curriculum. Objective: To collect the interns perception about the content, need and application of biochemistry knowledge during their internship using a pre-designed and pre validated questionnaire. Materials and Methods: It was a cross sectional study done on interns who were asked to give feedback on biochemistry curriculum using the questionnaire. All the opinions were rated using 5- point Likert scale, ranging from strongly disagree to strongly agree. Results: 72.9% of interns were in favor of integrating basic science subjects with clinical sciences . Around 74.5 % (2/3rd) expressed that adopting interactive teaching strategies and problem based learning helped them in better understanding of the subject. Conclusion: The final goal of teaching in a medical sector includes attainment of knowledge, skills, attitudes and morals required to perform professional tasks safely and competently. In order to achieve this interactive, practical/case oriented and integrated teaching should be promoted.
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Scedosporium prolificans have been reported to be resistant to all antifungals including the newer azoles and echinocandins. We report an unusual case of repeated S. prolificans infection of the heart valves in an immunocompetent patient.
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Background: Rabies is an enzootic and epizootic disease worldwide. In India it is estimated that the number of death due to rabies may be 10 times more than those reported. There are many myths and false beliefs associated with dog bite. 99% of all human deaths due to rabies are occurring in the developing countries. The present study was conducted to study awareness and perception about dog bite cases in the rural area of Maharashtra. Objectives: 1) To determine the knowledge of people about dog bites. 2) To assess the awareness of people pertaining to rabies and anti-rabies vaccination. 3) To study the behavioural practices of people after the dog bites. Methods: A Cross-sectional study was conducted in the rural field practice area of a medical college, Pune, Maharashtra. Study was conducted with the help of pre-tested, semi-structured questionnaire for the period of one month and people attending RHTC OPD were included in the study. All individuals above the age of 18 years were included in to the study. Informed consent was taken prior to conduct of the study. Results: Total 144 participants included in the study, 75 (52%) were females and rest were males 48%. Out of these 111 (77%) were aware about dog bite causes disease and among these 52 (46.8%) were aware that dog bite causes rabies. Among the participants, 138 (95.8%) were aware about the vaccine availability and 125 (90.5%) knew vaccine is available in Government Hospital. In the study 88% of dog bite victims received treatment. Conclusions: There is lack of awareness regarding dog bite and its management among the rural population.
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Background: Abnormal uterine bleeding is one of the commonest complaints in women and when it occurs without organic lesions like tumor, inflammation, it is called as dysfunctional uterine bleeding. Aim of current study was to find out the histopathological pattern of endometrium in Abnormal Uterine Bleeding (AUB) also to study organic causes of AUB. Methods: Specimens received as endometrial curettage and hysterectomy specimens were studied followed by correlation of histopathology with age and clinical presentation. Results: The patients were mainly from the age group of 30-49 years (74.24%). The most common menstrual disorder was menorrhagia (46.86%). In dysfunctional uterine bleeding the most common histological pattern of endometrium includes proliferative endometrium (22.8%) followed by endometrial hyperplasia (19.40%), atrophic endometrium (7.16%), secretory endometrium (5.97%), irregular shedding [1.80%], irregular ripening (1.20%) and anovulatory endometrium (0.59%). Organic lesions encountered in AUB cases were leiomyoma (17.92%), endometrial polyp (1.79%), endometrial carcinoma (1.50%), endometriosis (0.59%) and choriocarcinoma (0.29%). Conclusion: It is important to know the histological pattern of the endometrium like proliferative endometrium, endometrial hyperplasia, atrophic endometrium, secretory endometrium, irregular ripening and shredding and organic lesions in patients diagnosed as AUB in different age groups since recognition of these conditions will help and will avoid further complications.
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Background: In an attempt to make primary health care services available, especially, to the poorest and most vulnerable segments of rural & tribal society, JSY forms a crucial component of the NRHM. JSY is a safe motherhood intervention initiated to reduce maternal and neo-natal mortality and increasing institutional deliveries in them. Objective: 1) To assess awareness about Janani Suraksha Yojana (JSY) among ANC registered women. 2) To establish association of socio-demographic factors with awareness about Janani Suraksha Yojana (JSY). Methods: A cross sectional study was conducted in Primary Health Centre, Khardi of Thane district of Maharashtra during the period of Oct. 2010. A total of 110 ANC registered women were interviewed using pre-designed questionnaire. Results were analyzed by using SPSS version-15. Chi-square test was applied and p < 0.05 was considered as statistically significant. Results: More than half of the women (52.7%) were aware about this governmental scheme & only 17.24% of them were able to answer the correct name of the scheme. They obtained this knowledge mainly from the ANMs (58.6%), AWWs (22.4%) and ASHAs (17.2%). About 54.5% women had the knowledge about the components of JSY. Poor socioeconomic class, backward caste (SC/ST) & skilled/unskilled type of occupation were found to be significantly associated with the presence of knowledge about JSY. Conclusion: As the awareness and knowledge in our study group was less compared to other studies, there is a need to intensify the efforts to increase awareness and knowledge about JSY.
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Background: Reproductive tract infections (RTIs) represent a major public health problem in developing countries. Integrating RTIs/STIs management and early detection of cervical dysplasia in broader reproductive health services can improve women’s health. The objectives of the study were 1. To study the association of socio-demographic & reproductive factors among self-reported symptomatic women for reproductive tract infections. 2. To carry out clinical examination & feasible tests like PH, gram staining, VDRL for reproductive tract infections. 3. To study Pap smear among study subjects. Methods: A cross sectional study community based study was carried out in villages under ‘Parol’ Primary Health Centre of Thane district, Maharashtra, India. A total of 415 married women in reproductive age group were interviewed and examined. Pre-structured, pre-designed questionnaire was used. Clinical examination & feasible laboratory tests were done. Results were analyzed with the help of Microsoft Excel & SPSS 15. Results: A total of 415 women were interviewed, of them 263(63.4%) had one or more symptoms of reproductive tract infections. On examination, 69(35%) had cervicitis and 30(15.2%) pelvic inflammatory disease, 39(19.8%) bacterial vaginosis and candidiasis in 61(31%). Cervical erosion was present in 147(74.6%) women. On Pap smear, 20(10.2%) women had ASCUS (Atypical squamous cells of undetermined significance). Only 2(1%) women found HIV positive. No woman was found VDRL reactive. Conclusion: Routine RTI/STI screening and periodic surveys to detect the infection patterns which will helps to control HIV infections in the community is needed in the remote tribal area as the current study shows high prevalence of reproductive tract infection.
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Background: The logical thinking of medical practitioners play significant role in decision making about diagnosis. It exhibits variation in decisions because of their approaches to deal with uncertainties and vagueness in the knowledge and information. Fuzzy logic has proved to be the remarkable tool for building intelligent decision making systems for approximate reasoning that can appropriately handle both the uncertainty and imprecision. Aims & Objective: To develop a generic fuzzy expert system framework that can be used to design specific fuzzy expert systems for particular medical domain. Material and Methods: The generic fuzzy expert system has been designed for diagnosis of cardiac diseases. The interface between visual basic and MatLab is powerful feature of the system that offers user friendly graphical user interface. Results: Need to arrive at the most accurate medical diagnosis in a timely manner is the main outcome that may reduce the further complications. A generic fuzzy expert system for the diagnosis of various heart diseases yields better result than the classic designed systems, because this system simulates the manner of an expert in true sense. Conclusion: The particular focus is on diagnosis of heart disease by employing the fuzzy logic in expert systems. The system has been designed and tested successfully. Exhaustive rule base specifically formed for almost all heart diseases ensures the accuracy to arrive at certain decision.
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Out of 45 actinomycetes isolated from garden soil, pond water and air; fifteen showed good emulsification activity. Streptomyces sp. S22 isolated from garden soil produced maximum bioemulsifier with 0.5% (v/v) sunflower oil during stationary phase at 37°C, pH 6 and 250 rev/min. Emulsification activity was maximum (320 EU/ml) with sunflower oil as substrate. Partially purified bioemulsifier from Streptomyces sp. S22 was a peptidoglycolipid containing lipid (51.25%), protein (30%), non-reducing sugar (17.75%) and reducing sugar (1%). The yield of partially purified bioemulsifier was 1.6 g/l and reduced the surface tension of water by 23.09 mN/m. The bioemulsifier produced by Streptomyces sp. S22 was stable at room temperature for seven days.
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BACKGROUND: The VDR protein is at the centre of the vitamin D endocrine system, a complex physiological system with substantial feedback regulatory mechanisms involved in maintaining serum calcium and 1, 25 dihydroxy vitamin D3. Variations in VDR gene are shown to have implications in several diseases and have also been implicated as an important genetic factor affecting bone mass. AIM: To determine the frequency of Fok I and Taq I variants in healthy Indian individuals and its association with 25-OH-Vitamin D levels. SETTINGS AND DESIGN: Blood samples were collected from 143 unrelated normal individuals (Male-84 and Female-59) and their genotypes determined. MATERIALS AND METHODS: After amplification by polymerase chain reaction, each polymorphism was genotyped by restriction fragment length polymorphism. For 100 normal healthy individuals 25-hydroxyvitamin D estimation was done using DiaSorin kit method. STATISTICAL ANALYSIS: Graph pad software was used to calculate the P values from the Chi-square. RESULTS: Out of 143 samples analyzed for FokI and TaqI polymorphisms the following genotypic frequency was obtained FF 59%, Ff 36%, ff 5% and TT 49%, Tt 43%, tt 8% respectively. CONCLUSIONS: Results indicate that the distribution of the polymorphic loci Fok I and Taq I vary considerably not only in different populations, but also within India. Furthermore, when the genotypes were analyzed with respect to 25-OH-Vitamin D levels, a significant association was seen for the Taq 1 SNP but not with the Fok I.