Biomedical Waste Management: A Study of Knowledge, Attitude, and Practice Among Medical, Dental and Nursing Students in a Teaching College

Background: Bio-medical waste is perilous and can be a health hazard. Medical, dental and nursing graduatesspend maximum time during their clinical posting with the patients which increases their chance of exposureand risk related to biomedical waste. Therefore, they need to be aware about biomedical waste management.Purpose: To assess the Knowledge, Attitude and Practices (KAP) regarding biomedical waste managementamong medical, dental and nursing students. Material and Methods: This cross-sectional study was carriedout to access the knowledge and awareness about biomedical waste. The structured self-administeredquestionnaires were used for data collection. Results: Out of the total 300 students enrolled in this study(Group I: Medical, Group 2: Dental, Group 3: Nursing students), 20 medical 13 dental and 23 nursing failed torespond to the questionnaire. MBBS students had more knowledge but better attitude towards BMWmanagement guidelines were seen in nursing students (p<0.001). 86% of the participating candidates hadcorrect knowledge about definition of BMW. Only around 38% of candidates had knowledge of segregationof waste but none had knowledge of correct colour coding. 88% of candidates confirmed that recordmaintenance was essential but they did lack to answer what kinds of records are important to maintain forbiomedical waste management. 94% of the participating candidates said that BMW is teamwork. Conclusion:There is a need for rigorous training programme and monitoring for medical students

Incidence, bacteriological profile and risk factor analysis of neonatal sepsis in a peri urban set up of North India

Background: The high incidence and antimicrobial resistance among the pathogens causing neonatal sepsis is alarming. In addition to substantial immediate mortality, survivors of infections in the neonatal period are at increased risk of long-term disability. The present study was conducted to know the bacteriological profile and risk factors associated with culture proven neonatal sepsis in a peri urban population.Methods: This study was conducted over a period of 4 year (2015-2019). On clinical suspicion, blood culture specimens were sent to microbiology laboratory. The organisms isolated from blood cultures were identified and tested for antimicrobial susceptibility. As part of infection control practices, environmental samples from the neonatal intensive care units were tested.Results: Of 907 blood cultures of neonates received in the microbiology laboratory, 20.7% were culture positive. Majority of the episodes occurred at or before 72 hours of life (81.4%). 54.3% were Gram positive cocci including Coagulase negative Staphylococci, Staphylococcus aureus and Enterococcus spp. The common Gram-negative pathogens included Escherichia coli, Klebsiella spp. and Pseudomonas spp. Common risk factors involved were preterm birth, low birth weight, premature rupture of membrane, prolonged labour and iatrogenic causes.Conclusions: The early signs of sepsis are often subtle and nonspecific. Therefore, a high index of suspicion is needed for early diagnosis. Rapid, reliable detection and appropriate case management can save lives of many new-borns.

Increasing number of secondary dengue cases: a concern

ackground: Dengue fever is caused by mosquito borne arbovirus of family Flaviviridae, Aedes agypti as the principle vector. In the recent past Delhi has witnessed several outbreaks affecting thousands of individuals and many of them get re-infected during subsequent years forming a bulk of secondary dengue cases putting them at risk of developing severe dengue.Methods: A total of 150 serum samples from suspected dengue cases were tested for dengue fever by NS-1 antigen and IgM antibody enzyme-linked immunosorbent assay (ELISA) followed by categorization into primary and secondary dengue using IgG avidity ELISA.Results: Out of total 150 clinically suspected dengue cases, 56 were positive either by Dengue NS-1 antigen or dengue IgM antibody or both. On the basis of dengue IgG avidity ELISA among 56 diagnosed dengue cases, 30 (53.57%) were found to be of secondary dengue.Conclusions: There is increasing trend of dengue cases in Delhi since past one decade. Being hyper-endemic area for dengue, more than 25% population have been reported to have past infection of dengue. Due to increased prevalence and simultaneous circulation of more than one serotypes, number of secondary dengue cases is also increasing. Since majority of severe dengue cases are associated with secondary dengue, early diagnosis and treatment can significantly reduce the fatal outcome. Thus, avidity testing for IgG antibody becomes an important tool.

DNA damage in buccal cells in oral PMDs and malignant disorders by comet assay: a comparison with blood leukocytes

Aim: DNA damage associated with Oral Squamous Cell Carcinoma (OSCC) and potentially malignant disorders (PMDs) is produced due to carcinogenic agents or increased oxidative stress. Comet assay can assist in early detection and evaluation of the amount of DNA damage; lymphocytesare the most commonly used cells for performing comet assay. Utilisation of buccal epithelial cells in comet assay can be a minimally invasive and rapid method. The present study compared the efficacy of comet assay in assessing DNA damage in buccal cells over peripheral blood leucocytes (PBLs) in oral potentially malignant and malignant disorders. Methods: The study included fifty five patients each of Leukoplakia, Oral Submucous Fibrosis (OSMF) and OSCC along with fifty five healthy individuals as control. Buccal epithelial cells were collected from all the selected subjects. DNA damage was evaluated bymeasuring the mean tail length (µm). Results: A significantly increased mean tail length (µm) and higher DNA damage were found in OSCC (26.1096 + 1.84355) and there was a progressive stepwise increase in mean tail length from control(8.4982 + 0.93307) to PMD [leukoplakia (14.6105 + 0.71857); OSMF (12.5009 + 1.12694)] to OSCC.The mean tail length in different habit groups was greater than controls, though no significant difference was noted between habit groups. The mean tail length of buccal cells was significantly greater than the mean tail length of PBLs in all study groups and controls. Conclusion: Hence, use of comet assay on buccal epithelial cells can prove to be beneficiary for evaluation of DNA damage

An Introduction To Mathematical Modelling

Current medical research literature is increasingly relying on computer controlled mathematical models of medical outcomes. However, consumers of medical research usually lack the background knowledge of mathematical modelling and an understanding of the methods that are used to construct these models. This often results in readers blindly accepting the interpretations presented with the help of mathematical models. Therefore, a basic knowledge of the concepts of mathematical models will provide the readers of scientific literature with the insight needed to critically evaluate such findings.

Comparison of multiplex RT‑PCR and real‑time HybProbe assay for serotyping of dengue virus using reference strains and clinical samples from India.

Background: Dengue virus serotyping is crucial from clinical management and epidemiological point of view. Aims: To compare efficacy of two molecular detection and typing methods, namely, multiplex reverse transcription polymerase chain reaction (RT‑PCR) and real‑time Hybprobe assay using a panel of known dilution of four reference Dengue virus strains and a panel of sera collected from clinically suspected dengue patients. Settings: This study was conducted at a tertiary‑care teaching hospital in Delhi, India. Materials and Methods: Dengue serotype specific virus strains were used as prototypes for serotyping assays. Viral load was quantified by quantitative real time reverse transcription polymerase chain reaction (qRT‑PCR). Acute phase serum samples were collected from 79 patients with clinically suspected Dengue fever on their first day of presentation during September‑October 2012. Viral RNA from serum and cell culture supernatant was extracted. Reverse transcription was carried out. Quantitative detection of DENV RNA from reference strain culture supernatants and each of the 79 patient samples by real‑time PCR was performed using light cycler Taqman master mix kit. Serotyping was done by multiplex RT‑PCR assay and Hybprobe assay. Results: The multiplex RT‑PCR assay, though found to be 100% specific, couldn’t serotype either patient or reference strains with viral load less than 1000 RNA copies/ml. The Hybprobe assay was found to have 100% specificity and had a lower limit of serotype detection of merely 3.54 RNA copies/ml. Conclusions: HybProbe assay has an important role especially in situations where serotyping is to be performed in clinical samples with low viral load.

Distribution pattern of HCV genotypes & its association with viral load.

Background & objectives: Hepatitis C virus (HCV) has emerged as a leading cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma worldwide. Genotyping and assessment of the viral load in HCV patients is important for designing the therapeutic strategies. Thus the present study was designed to determine the distribution pattern of HCV genotypes in chronic hepatitis patients and their association with the viral load and biochemical profiles. Methods: Seventy one HCV RNA positive patients were included in the study. HCV genotyping was carried out by restriction fragment length polymorphism (RFLP) followed by the direct sequencing of the core region. Viral load estimation was carried out by Taqman real time PCR system. Results: Sixty three per cent (45/71) of cases were infected with genotype 3 followed by genotype 1 in 30.98 per cent (22/71) and genotype 2 in 5.63 per cent (4/71) of cases. Genotype 1 was associated with a significantly (P<0.001) higher viral load as compared to genotypes 3 and 2. There was no significant difference seen in the biochemical profile between the three groups of genotypes except in the levels of SGOT. The commonest mode of transmission was parenteral which accounted for 68 per cent of all the infected cases. Interpretation & conclusions: The present study revealed that HCV genotype 3 and 1 accounted for approximately 95 per cent of the HCV infection in Delhi and surrounding areas. Also two atypical subtypes like 3i and 3f were identified. Genotype 1 was associated with more severity of liver disease as compared to genotypes 3 and 2 as assessed by viral load.

Seroprevalence of hepatitis viruses in patients infected with the human immunodeficiency virus.

OBJECTIVE: The co-infection of Hepatitis B and C viruses with HIV accelerates disease progression and also has an effect on the management of patients infected with HIV. The prevalence of HIV co-infection with hepatitis viruses varies widely. This study is planned to evaluate the prevalence of HIV co-infection with Hepatitis B and C viruses in North India. MATERIALS AND METHODS: A total of 1178 patients enrolled in the ART center were retrospectively analyzed for the presence of HBV and HCV on the basis of the presence of HBsAg and anti-HCV markers. RESULTS: In patients infected with HIV, the prevalence of co-infection with HBV was 9.9% (117/1178), the prevalence of co-infection with HCV was 6.3% (74/1178) and the prevalence co-infection with both HBV and HCV was ~1% (12/1178). DISCUSSION: The prevalence rate of HBV and HCV are increasing in patients infected with HIV. Having acquired the knowledge about the importance of such a co-infection, it is essential that all the patients infected with HIV be screened for HBV and HCV co-infection.

Prevalence & risk factors for hepatitis C virus among pregnant women.

BACKGROUND & OBJECTIVE: Information on hepatitis C virus (HCV) infection in pregnant women in India is scanty. This study was carried out to investigate the prevalence of HCV within an obstetric population in north India and to identify the various risk factors for the viral infection. METHODS: A total of 8130 pregnant women from antenatal clinic were subjected to anti-HCV testing by third generation ELISA. Anti-HCV positive seropositive women were further tested for HCVRNA, hepatitis B and HIV. The women were evaluated for the presence of following known risk factors for HCV infection. RESULTS: Eighty four (1.03%) pregnant females had HCV antibodies. Of these, 46 (54.8%) were positive for HCV-RNA, 4(4.8%) tested positive for HBsAg, while none tested positive for HIV. The mean age and parity of the anti-HCV antibody positive women was 24.36+/-3.6 yr and 0.9+/-0.8, while that of the anti-HCV antibody negative women was 24.13+/-3.6 yr and 0.8+/-0.8 respectively. Of the 84 anti-HCV positive women, 52 (61.9 %) did not have any identifiable risk factors. The risk factors variables did not have significant association with HCV positive status. INTERPRETATION & CONCLUSION: Prevalence of hepatitis C in pregnant women was 1.03 per cent. None of the known risk factors was found to be significantly associated with the HCV infection. Hence case identification and consequent management pose a particular problem and routine screening is not a viable option in our resource- poor setting.

Circulating levels of tumour necrosis factor-alpha & interferon-gamma in patients with dengue & dengue haemorrhagic fever during an outbreak.

BACKGROUND & OBJECTIVE: Dengue haemorrhagic fever (DHF) is a severe illness caused by dengue viruses, the pathogenesis of which is not fully understood. Immune enhancement caused by cytokines, interferon and activated complement system is one of the hypotheses proposed to explain the haemorrhagic form of disease. This study was undertaken to investigate the role of pro-inflammatory cytokines tumour necrosis factor alpha (TNF-alpha) and interferon gamma (IFN-gamma) in dengue infection, and their possible association with disease severity. METHODS: Blood samples were collected from 60 patients; 28 patients of DF and 32 of DHF (clinically categorized into DF or DHF as per WHO criteria) from September to November 2003 at Delhi. Fifteen healthy individuals were included as control. All the patients were confirmed positive for dengue infection by serology or by reverse transcriptase-polymerase chain reaction (RT-PCR). Serum levels of TNF-alpha and IFN-gamma were determined by ELISA. RESULTS: The levels of both the cytokines were significantly elevated in the disease group as compared to the control group. Significantly higher levels of TNF-alpha; 258.02 pg/ml (P<0.005) were seen in patients having secondary infection, while patients with primary infection had higher level of IFN-gamma; 29.47 pg/ml (P<0.005). TNF-alpha was elevated in the later phase of illness, while IFN-gamma was elevated in early phase also. INTERPRETATION & CONCLUSION: Overproduction of TNF-alpha during secondary infection may have a role in immunopathogenesis of DHF, however, study of other cytokines produced along with IFN-gamma;, during the course of dengue infection is required to know the specific role of IFN-gamma in DI.

Rubella prevalence and its transmission in children.

Rubella is a major cause of birth defects among the TORCH group of agents causing congenital anomalies. Almost all the symptomatic infected infants have long-term neurological sequelae & many asymptomatic infants also develop deafness or psychomotor retardation later in life. In India need for rubella prevention & control is being recognized. Before formulating any kind of rubella vaccination policies, data on the burden of disease is important. Hence the prevalence of rubella in children and their transmission was evaluated. Paired sera of 146 babies with suspected intra uterine infection and their mothers from lower socioeconomic strata was tested for IgM antibodies by commercially available Enzyme immunoassay (EIA) kits. Congenital Rubella Syndrome (CRS) was confirmed in babies presenting with rubella compatible defects with positive IgM antibodies against rubella. It was seen that out of 146-paired samples evaluated, 15-paired samples (10.27%) were positive for IgM antibodies. The transmission rate of rubella virus from mother to child when the mother was infected was around 55.55% according to this study. CRS prevalence of 10.27% among symptomatic infants is significant as a large majority of rubella infection remains undetected and hence the actual burden of the disease may be higher. Since the disease is preventable by an effective vaccination, strategies for rubella immunization should be developed and enhanced.

Characteristics of dual infection of hepatitis B and C viruses among patients with chronic liver disease: a study from tertiary care hospital.

The major causes of chronic liver disease (CLD) are infection with Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) either alone or together. The clinical course of the disease varies in cases ofcoinfection with HCV and HBV as compared to single infection. The present study was carried out to determine the occurrence of coinfection of HCV with HBV in CLD patients and to look for the presence of suppressive effect of the two viruses on each other. The severity of liver disease was also assessed and correlated with biochemical profiles. Sera from 150 patients of CLD were tested serologically for the presence of HBsAg, IgG anti HBc and anti-HCV antibodies. HBV DNA and HCV RNA were also detected by amplifying surface region and 5' noncoding-core region respectively by polymerase chain reaction. Forty-seven (31.3%) cases showed the presence of HBsAg or anti IgG-HBc or HBV DNA either alone or together (Group A). Thirty-nine (26%) cases were found to be positive for HCV by detecting either anti-HCV antibodies or HCV RNA (Group B). Coinfection ofHCV with HBV (Group C) could be detected in twenty-four (16%) cases, of these twenty-one cases (87.5%) were positive both for HCV RNA and IgG anti-HBc without the presence of HBV DNA whereas in none of the cases could HBV DNA be detected in the absence of HCV RNA. Forty (26.6%) cases had neither HCV or HBV related CLD. Amongst, the biochemical parameters, the liver function test profiles were altered and found to be statistically significantly in HCV positive cases (Group B) when compared to the negative ones while in case of HBV (Group A) and coinfected (Group C) cases none of the parameters was statistically significant when compared with non-HBV and non-coinfected cases respectively. Thus, coinfection of HCV with HBV is seen in a substantial number of CLD cases. It is also revealed from the present study that HCV infection has a suppressive effect on the replication of HBV as seen by the loss of replicative markers like HBV DNA.

The 2003 outbreak of Dengue fever in Delhi, India.

Dengue fever (DF) and Dengue hemorrhagic fever (DHF) are widespread in Southeast Asia. An outbreak of DF/DHF in Delhi in 2003 started during September, reached its peak in October-November, and lasted until early December. This study describes the clinical and laboratory data of the 185 cases of DF/DHF admitted to Lok Nayak Hospital, New Delhi. The mean age of the patients was 26 +/- 10 years. Fever was present in all the cases with an average duration of fever being 4.5 +/- 1.2 days with headache (61.6%), backache, (57.8%), vomiting (50.8%) and abdominal pain (21%) being the other presenting complaints. Hemorrhagic manifestations in the form of a positive tourniquet test (21%), gum bleeding and epistaxis (40%), hematemesis (22%), skin rashes (20%) and melena (14%) were also observed. Hepatomegaly and splenomegaly were observed in 10% and 5% of cases, respectively. Laboratory investigations revealed thrombocytopenia (with a platelet count of < 100,000/microl) in about 61.39% of cases, Leukopenia (WBC <3,000/mm2) and hemoconcentration (Hct >20% of expected for age and sex) were found in 68% and 52% of the cases, respectively. The mortality rate was 2.7%. Despite widespread measures taken to control outbreaks of DF, it caused major outbreaks. More stringent measures in the form of vector control, improved sanitation and health education are needed to decrease morbidity, mortality and health care costs caused by a preventable disease.

Molecular epidemiology of rotavirus in Delhi.

Rotavirus is now established as an important cause of childhood diarrhoea throughout the world. Despite the availability of more advanced techniques for HRV characterization, electropherotyping was employed in this study to demonstrate the occurrence of diverse electropherotypes & any aberrant types thereof in isolates from children with acute gastroenteritis in Delhi, keeping in mind the ease of availability, performance and discriminatory power. Faecal specimens from 1172 children suffering from acute gastroenteritis were subjected to enzyme linked immunosorbent assay (ELISA) and polyacrylamide gel electrophoresis (PAGE). A total of 158 rotavirus strains were detected and electropherotyped by PAGE. Rotavirus was detected in 13.48% of the samples. A total of 10 electropherotypic patterns were observed to be in circulation. There was predominance of the long type over the short type and long type G was the most common isolate. The present study highlights the simultaneous coexistence of different electropherotypes of Human rotavirus strains circulating in Delhi and stresses the need for constant monitoring of the genomic diversity resulting from extensive genomic variation among Rotaviruses.

Evaluation of a rapid immunochromatographic test in the diagnosis of dengue fever.

Serology is the mainstay of diagnosis in Dengue virus infection. Various rapid tests for antibody detection have been developed. They can prove to be important diagnostic tools especially in the field set up due to technical simplicity. We evaluated a Rapid immunochromatographic assay The rapid test was performed on acute phase sera collected from patients suspected to be suffering from Dengue fever/DHF. These samples were then tested by Dengue Duo Capture ELISA and compared The rapid test showed a good sensitivity for the detection of secondary dengue infection and thus can be a good screening tool.