Prevalence and in vitro susceptibility pattern of MRSA,VRSA, VISA isolates from various clinical samples in tertiary care hospital

Background: Staphylococcus is notorious for its ability to become resistant to antibiotics. MRSA emerged as nosocomial pathogen in the early 1960. Methicillin Resistant Staphylococcus aureus are implicated in serious infections and nosocomial infection outbreaks, thus limiting the treating options to very few agents such as vancomycin and teicoplanin. Vancomycin has been regarded as the first line drug for the treatment for MRSA but its irrational use lead to emergence of vancomycin resistance. The Aim was to determine the prevalence and resistance of MRSA ,VRSA,VISA isolates from various clinical samples in a tertiary care hospital.Material & Methods:This present prospective study was done in the Microbiology department of Government Medical College. The study was conducted for a period of one and half year i.e from January 2019 to June 2020. All the samples (pus, urine, blood, body fluids, sputum etc) were processed as per standard protocols.Results:Out of 26,471 samples, 6578(24.85%) were found to be culture positive. 1583 isolates were identified as Staphylococcus aureus. Among them 1278(80.7%) were MRSA, 21(1.3%) were VISA and 8(0.5%) were VRSA. Maximum number of MRSA isolates were obtained from orthopaedics ward (22.7%) and Intensive Care Unit and most of them were isolated from pus(45%) followed by blood (19.09%)samples. Among them highest resistance were observed against azithromycin (85.6%), followed by ciprofloxacin (63.5%) and least resistance to rifampicin and doxycycline. Majority of the VISA and VRSA strains were isolated from ICU followed by orthopaedics, surgery. Most of them were isolated from pus followed by blood and urine specimen and most were found to be multidrug resistant while they retained their sensitivity to Linezolid and Teicoplanin.Conclusions:As there is high prevalence of MRSA isolates so the treatment options are limited to vancomycin. Overuse of vancomycin can lead to emergence of VRSA strains. So the need for rational use in the infection-control practices to prevent transmission of MRSA as well as VISA strains. Strict implementation of hand hygiene, decolonization of MRSA carriers,and education of healthcare team will be quite helpful.

Reporting adverse events of ChAdOx1 nCoV-19 coronavirus vaccine (Recombinant) among the vaccinated healthcare professionals: A cross-sectional survey

Background & objectives: The safety of the ChAdOx1 nCoV-19 vaccine is a cause of concern for many who have been vaccinated. The people have multiple concerns and fear regarding the adverse events of the vaccine. Thus, this study was undertaken to establish the safety profile of ChAdOx1 nCoV-19 Corona Virus Vaccine (Recombinant) among the healthcare professionals. Methods: This was a descriptive cross-sectional survey. After taking clearance from the institutional ethics committee 1500 healthcare professionals, who had their vaccination in the past two weeks were selected. They were provided with an online survey proforma regarding adverse events following immunization (AEFIs) of COVID-19 vaccine developed using google forms with an informed consent form affixed to it. Results: A total of 1036 individuals participated in the study. The mean and median (inter quartile range) age of the participants was 37.7 ±11.25 and 35 (29-46) yr, respectively. Of these, 52.1 per cent were female, 29.3 per cent were doctors, 33.4 per cent were nurses and 9.5 per cent were paramedical staff. Forty six per cent participants experienced one or more minor AEFIs such as pain, tenderness, redness, etc. at the injection site. Fatigue (31.75%), generalized feeling of unwell (28.57%), muscle pain (23.16%) and fever (21.71%) were the most commonly reported systemic AEFIs followed by headache (20.07%), dizziness (10.03%) and joint pains (15.25%). Most of them experienced these AEFIs within 24 h of the first dose of administration. About 42 per cent of the participants took oral antipyretics/analgesics for managing the AEFIs. Interpretation & conclusions: ChAdOx1 nCoV-19 Corona Virus Vaccine was found to be associated with mild local and systemic AEFIs that were more common after the first dose as compared to the second dose. There adverse events could be dealt with oral over-the-counter medications, with no requirement of hospitalization

Study of EGFR mutations in head and neck squamous cell carcinomas

Introduction Squamous carcinoma is the commonest malignancy of the head and neck region. It is associated with high morbidity and mortality. Epidermal growth factor receptor (EGFR) regulates downstream signaling pathways through its tyrosine kinase (TK) domains that play a role in cell proliferation and survival. EGFR mutations have been found to occur between exons 18 to 21 on chromosome 7. Limited studies are available on EGFR-TK mutations in the head and neck squamous cell carcinoma (HNSCC) globally. This study explores EGFR mutations in 30 HNSCC cases presenting to a tertiary care hospital over a period of two years. Material and Methods Fresh tumor tissue was collected from the resection specimens of cases of primary HNSCC. Cases with pre-operative therapy were not included. Parameters in the form of patients' age, gender, smoking/tobacco intake, site of the lesion were recorded. Tumor parameters after histopathological examination were recorded in the form of TNM stage, tumor grade. DNA was extracted from fresh tissue of all the cases. EGFR Mutation Analysis Kit assay was used to detect mutations of the EGFR gene. PCR was run and results were analyzed. Results EGFR Mutations were found in 6.7%of the patients. There was no significant association of the EGFR Mutation with the studied parameters. Conclusion EGFR mutations are present in a subset of patients of HNSCC. Patients having these mutations may benefit from targeted therapy with tyrosine kinase inhibitors.

Cornerstone of healthcare: awareness and compliance of patient safety measures in a large tertiary care hospital

Background: The study was done to assess the awareness and compliance of patient safety measures among healthcare providers and patients in a tertiary care hospital in India, ascertain the gap in both the aspects, if any and recommend the measures to improve the same.Methods: Cross sectional study in which patient safety survey was administered to random sample of 400 healthcare providers and 200 inpatients. The awareness was assessed through predefined questionnaires and compliance was assessed by observation, demonstration of processes, audit of patient files and interview of patients. Descriptive statistics analyzed with SPSS. Data was analyzed using frequencies, percentages and using Chi-square test.Results: The level of awareness was acceptable among healthcare providers, but the compliance was not satisfactory. Thus, gap was significant for certain parameters. The range of awareness among the patients was wide as study included patients of varying demographic and educational level. The range of compliance was also wide but was low. Thus, the gap was significant.Conclusions: As a result of continuous training of the healthcare providers, the awareness was satisfactory but on the other hand, they were not complying which may be due to workload, forgetfulness, lack of resources etc. On the other hand, the level of awareness was found to be low among patients and compliance was further lower down the ladder which may be due to difference in education, socioeconomic status, hesitation to enquire etc.

Atypical presentation of congenital diaphragmatic hernia: case report

The Congenital diaphragmatic hernia generally presents with severe respiratory distress in the neonatal period and usually occurs once in every 2,000-3500 births. Late-presenting congenital diaphragmatic hernia (CDH) has been defined as CDH diagnosed after the neonatal period due to initial symptoms after the neonatal period or asymptomatic CDH found in the course of routine X-ray examination of the chest beyond the neonatal period. When late presentations occur, patients may be asymptomatic or may be critically ill with unusual respiratory and gastrointestinal symptoms. Case characteristics: 3yrs old female child presented with history of pain abdomen, abdominal distension, vomiting, respiratory distress and fever since 5days. Chest tube was inserted in view of left sided pleural effusion. Later on, diagnosed with diaphragmatic hernia. Outcome Child was operated, and diaphragmatic repair done and was discharged successfully after 38 days. Message: Congenital diaphragmatic hernia should be considered in the differential diagnosis of any child with unusual respiratory or gastrointestinal symptoms and abnormal chest radiographic findings.

A cross sectional study to find out the prevalence of type D personality and its associated factors among undergraduate students of a dental college in western Uttar Pradesh

Background: An individual personality is reflected in their thoughts, emotion and behavior. Type D personality is defined as joint tendency towards negative emotions and social inhibition. Type D personality is associated with anxiety, depression and psychological stress. The present study is conducted to assess the incidence of Type D personality in the under graduate dental students as they are prone to excessive stress in their education. To study the prevalence Type D personality in first year dental students and to study the various variables associated with type D personality.Methods: The personality of students was analyzed by using DS 14 questionnaire. Likert scale was used to calculate the personality score. The students scoring high on either or both subscales taking cut off value as 10 was considered as type D.Results: 15% students had only social inhibition and 7% students had only negative affectivity. 5% students had both social inhibition and negative affectivity. Overall, the prevalence type D personality was found to be 27% among the students of dental college. The type D personality students were significantly associated with habits like alcoholism.Conclusions: The early identification of Type D personality can be helpful both for physical and mental wellbeing and we can minimize its impact on health by adopting healthier life style, yoga and meditation, mentorship in early college days, emotional support etc.

Retrocaval Ureter with Proximal Hydroureteronephrosis Presenting as Flank Pain in a Child: A Rare Case Report with Review of Literature

Retrocaval ureter also referred to as pre-ureteral vena cava or circumcaval ureter is a rare congenital anomaly with the ureterpassing posterior to the inferior vena cava. Although it is a congenital anomaly, patients do not normally present with symptomsuntil the 3rd and 4th decades of life after a resulting hydronephrosis. We present the report of a 12-year-old male child with ahistory of right flank pain and associated right proximal hydroureteronephrosis. Diagnosis was confirmed with computerizedtomography urography, and an open surgical repair was done for the anomaly. The case is discussed here along with reviewof recent literature.

Predictors of mortality among neonates transported to tertiary care centre

Background: The neonatal transport in India has taken a giant leap in last years. For reducing the death among transported newborns, transport in well-equipped ambulance could play a vital role. As there is not much data available in Punjab on neonates being transported to tertiary care center so the present study was conducted to know the predictors of mortality in newborns transported to tertiary care center.Methods: The present study was an observational study conducted in neonatal intensive care unit of department of Pediatrics at SGRD institute of medical science and research, Amritsar, Punjab, India over a period of 18 months from 1st January 2017 to 30th June 2018. Total 121 neonates were enrolled in the study. History and clinical examination were done at the time of admission and the various study variables were statistically analysed.Results: Out of total 121 neonates, 76 were discharged, 12 expired and 33 left against medical advice. Mortality rate was 9.9%. Mortality was higher in neonates who had hypothermia, hypoglycemia, poor perfusion and bradycardia at the time of admission. Neonates with extremely low birth weight (<1 kg) and those admitted after 6 hours of age also had higher mortality.Conclusions: Predictors of mortality were hypothermia, hypoglycaemia, poor perfusion and bradycardia at the time of admission. New-borns require special care for stabilization before and during transport, which can be achieved by using specially equipped neonatal ambulances. So, these neonatal ambulances should be started in all states to decrease the neonatal mortality rate.

Study To Assess The Effectiveness Of Pranayama On Stress Among Elderly

Aim: Aim of our study was to assess the effect of pranayama on pretest & post test stress level in elderly control & experimental group. Study Design: An Institution based true experimental case control study was conducted on elderly people for a period of 4.2.2011 to 7.3.2011 residing in Pingalwara Amritsar. Study comprises randomly selected elderly of both sex including 30subjects each in experimental & control group. Exclusion criteria was age below 60years, elderly residing outside pingalwara and those not willing to participate. Methodology: Simple Random sampling technique &Standarized tool was used formethod of collection of data. Pretest stress level was analyzed in both groups by Depression anxiety stressScale &then Pranayama therapy was introduced to Experimental group & then Post test stress level was assessed in both the groups by Depression anxiety stressScale. Results:Paired ‘t’ test reveals that there is significant (p <0.05) difference between pretest& posttest stress scores of experimental group as during pretest 10% had extreme severe & 30% had severe further 33% had moderate & 27% of them had mild stress. However during post test only 3% had extremly severe & 10% had severe further 47% had moderate and 40% of them had mild level of stress. Pretest and Post test level of stress among the control group reveals that in the pretest 10% had extreme severe stress &20% of the elderly had severe stress further 40% had moderate & 30% of them had mild stress. However during post test 7% had extreme severe level of stress&20% had severe stress further 40% of the elderly had moderate and 33% of them had mild level of stress.

Cell surface proteins play an important role in probiotic activities of Lactobacillus reuteri

BACKGROUND: Eight Lactobacillus reuteri strains, previously isolated from breast-fed human infant feces, were selected to assess the potential contribution of their surface proteins in probiotic activity. These strains were treated with 5 M LiCl to remove their surface proteins, and their tolerance to simulated stomach-duodenum passage, cell surface characteristics, auto aggregation, adhesion, and inhibition of pathogen adhesion to Caco-2 cells were compared with untreated strains. RESULTS: The survival rates, auto aggregation, and adhesion abilities of the LiCl-treated L. Reuteri strains decreased significantly (p< 0.05) compared to that of the untreated cells. The inhibition ability of selected L. reuteri strains, untreated or LiCl treated, against adherence of Escherichia coli 25922 and Salmonella typh iNCDC113 to Caco-2 was evaluated in vitro with L. reuteri ATCC55730 strain as a positive control. Among the selected eight strains of L.reuteri, LR6 showed maximum inhibition against the E. Coli ATCC25922 and S. typhiNCDC113. After treatment with 5 M LiCl to remove surface protein, the inhibition activities of the lactobacilli against pathogens decreased significantly (p< 0.05). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis indicated thatLR6 strains had several bands with molecular weight ranging from 10 to 100 KDa, and their characterization and functions need to be confirmed. CONCLUSIONS: The results revealed that the cell surface proteins of L. reuteri play an important role in their survivability, adhesion, and competitive exclusion of pathogen to epithelial cells.

Surgical Management of Aberrant Labial Frenum Using Modified Z-Frenuloplasty: A Case Report.

Frenum is a mucous membrane fold that attaches lips and cheek to the alveolar mucosa, gingiva, and the underlying periosteum. The maxillary frenum can contribute to esthetic problems and can compromise the orthodontic outcome in cases of midline diastema, thus leading to treatment relapse. In addition to this, it may jeopardize the health of the gingival, when it is attached too tightly to the gingival margin, by interference in the plaque control or owing to the muscle pull. These situations can be managed with the help of frenectomy. The presenting case report demonstrates the frenectomy of an anomalous labial frenum in a 20-year-old male using modified Z-frenuloplasty technique.

Soft tissue ridge augmentation using “roll technique” – A case report.

The defects of the alveolar ridge can result from various causes, most common being the collapse of alveolar bone during extraction. Localized defects of alveolar crest impair prosthetic rehabilitation due to poor emergence profile of the pontic which in turn adversely affects the aesthetics and function. Several alternatives have been proposed to restore the damaged ridge by hard and soft tissue augmentation. Various soft tissue ridge augmentation techniques have been used to augment alveolar ridge with varying success. The present clinical report describes the “roll technique” as a means of soft tissue ridge augmentation to treat alveolar ridge defects.

Platelet Rich Plasma a Boon for Periodontal Regeneration: A Review.

Platelet rich plasma (PRP) is the component of blood that is rich in platelets. When put in the wound site, it accelerates the healing by using body’s natural healing responses. Th e aim was to review the concepts of PRP and its applications in the dental fi eld. MEDLINE, Google Scholar and EMBASE was searched using terms PRP, platelet concentrates, autologous platelet gel, plasma very rich in platelets. It has been substantiated in the literature that the PRP has an ability to enhance the regenerative process of the human body by using patient’s own blood. Th e application of PRP off ers the dental patient something that is safe from outside disease transmission or immunogenic reactions.

Primary primitive neuroectodermal tumor of kidney: A rare case report with diagnostic challenge.

Primary primitive neuroectodermal tumors (PNETs) of the kidney are quite rare and can be mistaken for a wide variety of other small round blue cell tumors which includes rhabdomyosarcoma, Wilm’s tumor, carcinoid, neuroblastoma, clear cell sarcoma of the kidney, lymphoma etc. Renal Ewings/PNET can occur in the age group from 4 to 61 years. Approximately, 90% of Ewing sarcoma (ES)/ PNET have a specifi c t(11;22) which results in a chimeric EWS-FLI-1 fusion protein. Immunohistochemical for the carboxy-terminus of FLI-1 is sensitive and highly specifi c for the diagnosis of ES/PNET. Herein, we have an interesting presentation in a 23-year-old male who came with neck pain and progressive quadriparesis and was diagnosed as a case of poorly differentiated malignant tumor with a differential of lymphoma versus metastatic renal cell carcinoma. The patient’s condition deteriorated fast and he had a rapid downhill course. The fi nal diagnosis of Ewings/PNET was confi rmed at autopsy.

Development of a peptide based latex agglutination assay for serotype identification of foot and mouth disease virus.

Out of 200 serum samples collected from cattle (142) and buffaloes (58) of various ages and sexand subjected to latex agglutination test (LAT) using serotype specific peptides (O, A, Asia 1) and also with peptide for non-structural protein 2B (NSP-2B), 114 (70%) samples were positive against FMDV type ‘O’, 102 (51%) against serotype ‘A’ and 104 (52%) against serotype ‘Asia 1’. With NSP-2B peptide a total of 71 (35.5%) samples were positive. The results suggest that LAT could be used for the diagnosis of foot and mouth disease virus as it is easy, cheap and effective test.

Growth, photosynthetic activity and oxidative stress in wheat (Triticum aestivum) after exposure of lead to soil.

The present study was conducted to assess quantitative information about lead (Pb) contamination in soil on the growth and physiology of wheat. Solutions with three different concentrations of Pb as [Pb(NO3)2 at 500, 1000 and 2500 >M] were incorporated into the soil to achieve Pb-stressed conditions in comparison to unstressed, water treated, control variant. Wheat growth measured in terms of root length, shoot length and dry weight exhibited a significant decline with increasing Pb concentrations in the soil. Root and shoot length and seedling weight declined in the range of ~23–51, ~17–44, and ~21–44% in response to 500 to 2500 >M Pb. In addition, there was a significant reduction in the levels of photosynthetic pigments-chlorophyll a (16-66%) and b (10-24%) and total chlorophyll content (by 14-39%) in plants growing in Pb-contaminated soil. It indicated a negative effect on photosynthetic activity in wheat and was confirmed by reduced photochemical efficiency of PSII (Fv/Fm) in the range of ~ 3-37% in response to 500 to 2500 >M Pb. The reduction in wheat growth in Pb-contaminated soil was accompanied by induction of oxidative stress as indicated by enhanced lipid peroxidation in terms of malondialdehyde (MDA) content (by 18-40%) and hydrogen peroxide (H2O2) content (by 34-123%) and alterations in the activity of enzymes, superoxide dismutases (SOD) and guaiacol peroxidases (GPX) in wheat roots. The study concludes that Pb in soil inhibits growth and phototsynthetic activity in wheat through induction of oxidative stress.

Detrimental effect of expression of Bt endotoxin Cry1Ac on in vitro regeneration, in vivo growth and development of tobacco and cotton transgenics.

High levels of expression of the cry1Ac gene from Bacillus thuringiensis cannot be routinely achieved in transgenic plants despite modifications made in the gene to improve its expression. This has been attributed to the instability of the transcript in a few reports. In the present study, based on the genetic transformation of cotton and tobacco, we show that the expression of the Cry1Ac endotoxin has detrimental effects on both the in vitro and in vivo growth and development of transgenic plants. A number of experiments on developing transgenics in cotton with different versions of cry1Ac gene showed that the majority of the plants did not express any Cry1Ac protein. Based on Southern blot analysis, it was also observed that a substantial number of lines did not contain the cry1Ac gene cassette although they contained the marker gene nptII. More significantly, all the lines that showed appreciable levels of expression were found to be phenotypically abnormal. Experiments on transformation of tobacco with different constructs expressing the cry1Ac gene showed that in vitro regeneration was inhibited by the encoded protein. Further, out of a total of 145 independent events generated with the different cry1Ac gene constructs in tobacco, only 21 showed expression of the Cry1Ac protein, confirming observations made in cotton that regenerants that express high levels of the Cry1Ac protein are selected against during regeneration of transformed events. This problem was circumvented by targeting the Cry1Ac protein to the chloroplast, which also significantly improved the expression of the protein.