Clinical profile and pattern of bacterial isolates from bile aspirates of cholecystectomy patients

Background: Antibiotic policy and appropriate antibiotic prophylaxis cannot be designed unless data is available about bacteria colonizing the bile associated with gall bladder disease.  Authors aim was to assess the clinical profile and pattern of bacterial isolates from bile aspirates of cholecystectomy patients seeking care at a tertiary care teaching hospital.Methods: Patients who underwent cholecystectomy for various hepatobiliary ailments during year 2017-18 formed the study population. Bile aspirates were collected during cholecystectomy and sent to the microbiology laboratory. Ultrasonography, computed tomography and MRCP were done to confirm the gall bladder pathology before surgery.Results: Out of total eighty-six patients, bacterial growth was observed in 28 (32.56%) subjects. As per division of bile samples, maximum number of study participants (39.29%) having bactibilia were seen in Group II. Group with second highest number of patients showing bactibilia was Group III with 9 subjects (32.14%). Eight subjects (28.57%) exhibited bacterial growth in bile aspirates in Group I subjects. Three patients (10.71%) showed bile infected with multiple bacteria i.e. polymicrobial infection. The gram-negative preponderance was seen in all the three groups with Escherichia coli being most common in group I and II. Pseudomonas aeruginosa was isolated in majority of the patients in group II and III.Conclusions: It is advised that all patients undergoing cholecystectomy must have their bile aspirated during cholecystectomy and sent for microbiological examination and culture. It will help in choosing appropriate antibiotic to prevent infection.

Clinico-bacteriological profile of spontaneous bacterial peritonitis in cirrhosis of liver with ascites

Background: A good and an effective empirical treatment of SBP is not possible unless bacteriological spectrum and their antibiogram is clear. This becomes more important in country like India due to high antibiotic resistance.  Authors aim was to assess the prevalence of SBP, clinical and microbiological profile of its variants, in patients with cirrhosis seeking care at a tertiary care teaching hospital.Methods: Patients of liver cirrhosis with ascites seeking care at study subject during January- December 2018 formed the study population. Diagnosis was based on clinical examination, biochemical investigation and ultrasonography. Diagnostic abdominal paracentesis was performed on subjects within 24 hours of admission. Ascitic fluid was aspirated. It was sent for microbiological examination.Results: Prevalence of SBP was 16.12%. Out of total ten subjects with Spontaneous Bacterial Peritonitis (SBP), six subjects were of Culture Negative Neutrocytic Ascites (CNNA). Thus most common (60%), variant of Spontaneous Bacterial Peritonitis (SBP) was Culture Negative Neutrocytic Ascites (CNNA). Prevalence of Mono-microbial Non-neutrocytic Bacterascites (MNBA) and Classic-Spontaneous Bacterial Peritonitis (C-SBP) was 20%.  Two subjects found positive for MNBA, Staphylococcus aureus and Acinitobacter spp. was detected in each patient. Klebseila pneumonia, Escherichia coli and Coagulase negative Staphylococcus were found in ascitic fluid culture of C-SBP. In clinical variants of SBP, 80% subject’s complaint about abdominal pain. Hepatic-encephalopathy and fever was seen in 7(70%) patients. Rebound tenderness was seen among 60%.Conclusions: Diagnostic paracentesis should be advised to all cirrhotic patients with ascites. Ascitic fluid analysis should be sent for better selection of antibiotics thus better outcome of cirrhotic patients.

Pattern of dermatologic manifestations in polycystic ovarian disease cases from a tertiary care hospital

Background: Dermatologists often play a significant role in its management. Cutaneous features of hyperandrogenism in Polycystic ovarian syndrome (PCOS) have varied presentation. Aim of this study was the pattern of dermatologic manifestations in polycystic ovarian disease in northern Indian females.Methods: Patients registering for treatment of polycystic ovarian disease at Dermatology outpatients department during April 2016 to March 2017 formed the study population. Residents interviewed the study subjects at the OPD. General physical examination, systemic examination, breast and pelvic examination, along with detailed dermatological examination were conducting after taking the history. Hormonal analysis was performed after an overnight fasting using enzyme immunoassay.Results: FSH and LH levels were 5.05�86 IU/L and 8.14�21 IU/L respectively. Testosterone levels were found to be 61.01�.32 ng/dl. DHEAS levels among them were 130.05�.21?g/dl. Two commonest cutaneous manifestations were hirsutism and acne seen in 83.8% and 59.5% of subjects. Female pattern hair loss was seen in 45.6% females. Three most frequent hormonal abnormalities noted in our study subjects were raised L/H ratio, testosterone and LH levels seen in approximately 45%, 35% and 21% cases.Conclusions: The cutaneous manifestations of PCOS reserve a major role in its management by dermatologists. A lifestyle modification along with systemic treatment remains mainstay of treatment. Monitoring for the foreseen cardiovascular risks should start early to downgrade the morbidity

Prevalence of Urinary Tract Infection in Patients attending Teerthanker Mahaveer Medical College & Research Centre and Hospital Moradabad

Background: It has been estimated that symptomatic urinary tract infections (UTI) occurs in around 7 million patients visiting to emergency units and 100,000 hospitalizations annually. It continues to be the most common cause of infection in hospitalized patients accounting approximately 40% of hospital acquired infections, and is the second most common cause of bacteraemia in hospitalized patients. Objective: a) To study the prevalence of UTI and its etiology in patients coming to the hospital. b) To study the susceptibility pattern of the isolate. Methods: The study was performed on 630 midstream urine positive samples taken from all age group patients, either male or female. Samples were collected prior administration of antibiotics in a sterile container. In case of cathetized patients, it is collected directly from catheter. Samples were inoculated on CLED agar. By colony count the stage of bacteraemia was assessed. To know the causative organism , colony morphology as well biochemical test were done. Results: The prevalence of Urinary Tract Infections (UTI) was evaluated in 630 patients attending Teerthanker Mahaveer Medical College & Research Centre, Moradabad for the duration of one year from February 2016 to January 2017. Results showed 215 (34.12%) patients were positive. Out of 215 positive cases 41(19.06%) were gram positive organisms and rest 174 (80.94%) were gram negative organisms. The most common pathogenic organisms were Escherichia coli accounting for 98(45.19%) urinary isolates. Among gram positive organism Enterococcus 26(12.09%) were the most common. In-vitro antibiotic susceptibility tests revealed that the gram negatives bacteria were sensitive to quinolones and Carbapenems, while the gram positive isolates were sensitive to glycopeptides antibiotics. Conclusions: The findings suggested the need for regular screening for the presence of symptomatic or asymptomatic bacteriuria for different populations and constant monitoring of susceptibility to commonly used anti-microbial agents.

Problem-based learning versus lecture-based learning in pharmacology in a junior doctor teaching program: a crossover study from northern India.

Background: The undergraduate MBBS training in our country is still in the traditional mode. The main part of the curriculum consists of lecture, tutorial, practical and ward teaching classes with a limited number of problem based session. The objective of the study was undertaken to compare PBL with LBL in terms of students’ knowledge retention in the subject of Pharmacology in undergraduate medical training. Methods: The current survey was planned and executed by the Department of Pharmacology in collaboration with Medical Education Unit, MSDS Medical College, Fatehgarh in the batch currently posted in the Department of Pharmacology for practical classes. Fifty MBBS students posted were enrolled for the study and were divided in 2 groups. One of the topics was presented as LBL for the first group and as PBL for the second group. The other topic was presented as PBL for the first group and as LBL for the second group. Intervention and control groups were taken as those used PBL and LBL respectively. T test was used to compare mean scores obtained by students in the intervention and control groups. Results: Mean scores obtained by students in the intervention group (topics learnt with PBL) were higher (3.80 Vs 2.84) than mean scores obtained by students in the control group (topics learnt with LBL). Mean scores obtained by students in the intervention group were higher (3.72 Vs 2.96) than mean scores obtained by students in the control group. Conclusions: The current study indicates usefulness of Problem-based learning (PBL) over Lecture-based Learning (LBL) in terms of retention of knowledge. However further studies involving more number of students are warranted in order to generate stronger evidence on this tool for improving medical education in our setup.

An evaluation of self medication among undergraduate medical students of a rural medical school from western Uttar Pradesh.

Background: Common problems related to self medication are wastage of resources and increasing antimicrobial resistance. They generally entail serious health hazards such as adverse reaction and prolonged suffering. Aim: The study aimed to analyze the pattern, factors influencing and potential adverse effects of self-medication among the undergraduate medical students Material and methods: The present cross sectional study was carried out by the Department of Pharmacology, MSDS Medical College, Fatehgarh among the undergraduate students currently studying in a rural medical school from western Uttar Pradesh. A 25 item self administered questionnaire was administered to the students in the classrooms just after completion of classes. Time allocated for the completion of the questionnaire was 30 minutes. After compilation of collected data, analysis was done using Statistical Package for Social Sciences, version 21 (IBM, Chicago, USA). Results: Data of 256 study subjects was analyzed. Overall prevalence of self medication among study subjects was found to be 71.5% (87.6% among males and 50.5% among females). 82.5% had trust in allopathic medicine system. 81.5% students learnt self medication from doctors prescriptions provided during their prior illness. Regarding categories of drugs commonly self-prescribed, they commonly used antipyretics (81.4%), anti-tussives (72.1%) and analgesics (68.9%). ‘Illness too trivial for consultation’ was the most common (71%) reason for self-medication cited by them. Almost 69% of them were aware of possible adverse effects. 7.7% of them even experienced the side effects of self-medication. Conclusion: The study highlighted growing trend of self-medication among medical students. Policies prohibiting the supply of medicines without a valid prescription should be enforced strictly. A robust monitoring system among the physicians and pharmacists is need of an hour.

A prospective study of incidence and assessment of Adverse Cutaneous Drug Reactions as a part of Pharmacovigilance from a rural northern Indian medical school.

Background: The wide and indiscriminate use of drugs has increased the incidence and the modes of presentation of cutaneous drug reaction. Understanding the nature of ACDRs may help narrow down the search for the offending agent. Aim- The study aimed to evaluate incidence, assessment of causality, severity and preventability of Adverse Cutaneous Drug Reactions as a part of Pharmacovigilance from a rural northern Indian medical school. Material and methods: The current survey was executed by the department of Pharmacology in collaboration with Department of Dermatology, MSDS Medical College, Fatehgarh among 7692 patients attending Dermatology OPD during March-December 2014. CDSCO ADR Reporting Form, WHO causality assessment scale, Hartwig and Siegel’s Assessment scale and Modified Schomock and Thronton’s preventability assessment scale were used as study tools. All the doctors, residents, interns and students were encouraged to notify any suspected ACDRs. Patients were screened and recruited if they presented with visible skin lesions suspected to be drug related. As per Modified Schumock and Thornton Scale, 43.5% of ACDRs were ‘Definitely preventable’ followed by ‘Probably preventable’ (30.4%) and ‘Not preventable’ (26.1%). Results: 23 patients (0.3%) were detected to have one or other type of ACDRs. Fixed drug eruption was most common form (34.8%) of ACDRs followed by Acneform eruption and Urticaria in 21.7% and 13% respectively among study subjects. The most common drugs responsible for ACDRs were prednisolone, betamethasone and isoniazid for Fixed drug eruption, while matronidazole, cotrimoxazole and paracetamol for acneform eruption. Antimicrobials, other steroids and NSAIDs were responsible for other spectrum of ACDRs. On assessment of Causality of ACDRs, it was noted that more than half (52.2%) of them fall under probable category. Severity assessment of ACDRs revealed that majority (65.3%) of them was moderate in nature. Conclusion: Awareness on part of the physician can help in timely detection of cutaneous reactions, thereby restricting damage from them. Pharmacovigilance activity is significantly effective in increasing the reporting of ADRs. Study with long-term follow-up and monitoring of the patients with bigger sample size is warranted.

Anatomic variations in the origin of the left circumflex coronary artery with angiography in Northern Indian population.

Introduction: Knowledge of the normal and variant anatomy and anomalies of coronary circulation is definitely a crucial component in the management of heart diseases. Complex cardiac surgical repairs demand enhanced understanding of the basic anatomy to improve the operative Outcomes Material and methods: The present study was planned by Department of Anatomy and was executed in collaboration with Department of Internal Medicine and Cardiology during 2010 to 2014 at a tertiary care teaching hospital located in western Uttar Pradesh. The angiographic data of 5,532 patients who underwent coronary angiography were considered for anomalous origin of the left circumflex coronary artery (LCx). Results: The incidence of anomalous origin of the LCx was found to be 0.36%. The LCx arose from the left coronary sinus of valsalva (there was separate orifice for the LCx and the left anterior descending coronary artery) in 45.0% patients, from the right coronary sinus of valsalva, (there was a separate orifice for the LCx and the right coronary artery) in 25.0% patients, from the proximal part of right coronary artery in 30.0% patients. Conclusion: On the basis of findings of the current study it can be concluded that, the anomalous origin of the LCx may not be benign all the time. In case where ischemia does not resolve accurately after successful treatment of a coronary stenosis, anomalous coronary arteries must be considered.

A rapid appraisal of factors influencing utilization of primary eye health services among the residents in a rural community.

Background: Identification of factors affecting utilization of primary eye health services would help the government and other eye care providers to address inequity issues in their eye care program. Aim: Therefore this study was planned to find out barrier to utilization of eye health services among people living in rural western Uttar Pradesh. Material and methods: The current community based cross-sectional survey which involved both qualitative and quantitative methods, was conducted among the residents. A total of 216 study subjects participated in the study. Factors in the supply side influencing utilization of eye health services by people from the community were sought through Focus Group Discussion (FGD) and Key Informant Interview (KII). Results: Almost 80% of the respondents had agriculture as their major occupation and > 1/4th were from lower caste community. Regarding the seeking of eye care services, 52.4% respondents who gave a positive history of an eye problem in the family told they attended the nearest health facility; CHC, PHC or SC while 19.2% did actually go to the eye health center. Only 4.8% respondent did not seek any service. Among 112 respondents who were aware of one or other eye diseases, 74.6% identified dirty things fallen into the eyes as the cause of an eye problem followed by 50.3% of the respondents who pointed out injury to the eyes as the culprit. For emergency problem in the eyes 79.2% respondents told that they sought services from health facilities without delay, while 15.4% gave priority to starting household treatment. Conclusion: Raising awareness of the community about eye diseases and the services available together with strengthening of primary eye health services available at the local health facilities could help bring eye health services in closer proximity to the rural population.

A study on perceptions about eye health care and promoting factors for eye donation among medical students from a tertiary care teaching hospital.

Background: Voluntary eye donation depends on the awareness levels of various stakeholders in the community. Today’s medical students are tomorrow’s stakeholders of the community. Medical professionals can enhance eye donation rates by educating and motivating the relatives in case of patient's death. Aim: Hence the present study was undertaken with an objective of assessing the promoting factors for eye donation among medical students. Material and methods: The present descriptive cross sectional study was carried out among undergraduate students of a medical college in western Uttar Pradesh in the month of February 2014 using pretested self administered questionnaire. Results: 77% students knew about eye donation. 51% of them were willing to donate their eyes. Only 39% students knew that the ideal time for eye donation is within 6 hours of death. 64% had knowledge about vitamin A’s important role in prevention of childhood blindness. TV, newspaper or other media were the most important channels of getting information for majority (60%) of the students. Regarding perceived promoting factors for eye donation by them, noble cause (57%), pleasure to help the blind (51%) and inspired by advertisement on television (42%) were 3 top most promoting factors. Conclusion: Inclusion of different preventive and promotive aspects of corneal blindness along with basic eye health care into the course curriculum is the need of the hour.

Prevalence of microbial infection and strategic pattern of antimicrobial resistance among intensive care unit patients in a tertiary care teaching hospital from rural Northern India.

Background: Better management of patients cannot be ensured and the antibiotic policy cannot be designed till one knows the profile of prevalent strains along with their antimicrobial resistance pattern. Objective: To assess the strategic patterns of the organisms and its resistance patterns that were isolated from the patients admitted in various ICUs in a tertiary care hospital. Material and methods: The present study was undertaken based on reports of bacterial isolates of various clinical specimens from different ICUs of a tertiary care teaching hospital, that were submitted to the Microbiology laboratory for culture and sensitivity during the period of October 2012 to September 2014. All the organisms were identified morphologically and biochemically by standard laboratory procedure and antibiotic susceptibility pattern was determined by disc diffusion methods. Results: Out of the total samples (2920) received; organisms were isolated from 66.57%. One organism was isolated in 71.19% samples whereas 2 or more organisms were obtained in 28.8% were obtained in 28.8% samples. The most frequently isolated bacteria were P. aeruginosa (38.17%). Among P. aeruginosa, tobramycin had the highest susceptibility rate (94.2%) followed by meropenem (93.93%), carbenecillin (79.11%), and levofloxacin (73.45%). Most of the frequently isolated organisms like K. pneumoniae, Acinetobacter anitratus, Enterobacter were highly resistant to ampicillin, cephalexin, cefepime, ciprofloxacin. Conclusion: Appropriate antibiotic utilization in ICU is crucial not only to ensure an optimal outcome, but also to prevent the emergence of multi drug resistance. Antibiotic policies and effective surveillance are needed for better management of ICU infections with resistant organisms, Alteration and rotation in antibiotic prescribing patterns would decline the antibiotic resistance.