Extended Spectrum Beta Lactamase producing Gram negative bacteria - An emerging menace in Neonatal Sepsis.

Introduction: Neonatal sepsis caused by extended spectrum beta lactamase (ESBL) producing Gram negative bacteria (GNB) is associated with significantly high mortality and morbidity. Clinical features and risk factors for such neonatal sepsis can help in identifying it early. Objectives: Aim of the study was to estimate the incidence, risk factors, clinical features and antibiotic sensitivity of GNB and outcomes of ESBL GNB in neonatal sepsis. Methodology: A prospective observational conducted at regional tertiary care health center. Statistical analysis was carried out with SPSS version 23.0. Results: A total of 87 cases of Gram negative neonatal sepsis were included in study. Male: female was 1.7:1. Forty nine (56.3%) isolates were ESBL positive strains. The clinical features in order of frequency were shock, lethargy, sclerema, disseminated intravascular coagulation and severe thrombocytopenia. Out born neonates (p=0.03), late onset sepsis (p=0.05) and mechanical ventilation (p=0.002) were the risk factors for ESBL GNB sepsis. Mortality associated with ESBL sepsis was 26.5%. Carbapenems and Piperacillin + Tazobactum were most sensitive antibiotics and high resistant for cephalosporins was observed. Conclusion: ESBL GNB neonatal sepsis is an emerging threat with high mortality in Neonatal Intensive care unit.

Ocular Manifestation in Hypertensive Patients of Jamnagar Disrict.

Hypertension affects millions of patients worldwide. Persistent elevation affecting the arteries and veins in eye can be the most accessible to clinically detect undiagnosed hypertension. Aim: To know the incidence of retinopathy due to hypertension in both sex and various age groups. The severity of hypertension and its relation with fundus changes is observed. Material and Methods: The Study was carried out at the department of ophthalmology in Shri Guru Gobind Singh Hospital. Detailed ophthalmic evaluation including dilated fundus and systemic examination of the patient is carried out in detail. Thereafter attempt is made to correlate the Fundus findings with age, sex, past history etc. For hypertensive retinopathy Keith-Wagener-Barker Classification is used. Result: Hypertension is most common in 5th to 6th decade of life. Males are more affected than females. Male to female ratio is 1.72. Fundus changes are observed maximum in grade II (26, 44.8%) followed by Grade I(15,21.9%), Grade III(11,19%) and minimal in Grade IV(6,10.3%).With incidence of hypertensive retinopathy in different age group shows that Grade II more number of cases 26 (44.8%) in 41-50 years of age group showing 8 cases. In complication of hypertensive retinopathy, 10 cases of macular edema, 6 cases of disc edema, 1 case of central retinal vein occlusion and 1 case of branch retinal vein occlusion are found. Conclusion: Incidence of hypertensive retinopathy is increased as age is increased with maximum presentation in 5th to 6th decade of life with male dominance with male:female ratio 1.72. Hypertensive retinopathy grade II is the most common retinopathy found. Higher systolic and diastolic blood pressure was associated with more severe retinopathy. Grade-III and Grade-IV hypertensive retinopathy was maximally associated with systemic involvement.

Study of psycho-social impairment in patients presenting with age related macular degeneration in a tertiary eye care hospital.

Background: Age Related Macular Degeneration (ARMD) is an eye condition affecting old age people causing severe vision loss. This study was carried out to assess the psycho-social impairment in the ARMD patients and compare it with the normal eye patients. Methods: A Two study groups were made: 1. ARMD patients. 2. Control group patients. Patients of both the groups were made to fill “The validated Gujarati version of: General Health Quality Questionnaire-28 (GHQ 28)”. Self-scoring was done according to 0-1-2-3 lower to higher disability respectively. Results: Prevalence GHQ Mean score of ARMD patients was 34.27 and that of normal eye patients was 24.66. 80.85% of ARMD patients and 26.73% of normal eye patients were psychosocially impaired. Conclusion: ARMD patients are psychosocially more impaired as compared to control group patients (p value <0.001, highly significant).

A robust HIV-1 viral load detection assay optimized for Indian sub type C specific strains and resource limiting setting

BACKGROUND: Human Immunodeficiency Virus Type 1 (HIV-1) viral load testing at regular intervals is an integral component of disease management in Acquired Immunodeficiency Syndrome (AIDS) patients. The need in countries like India is therefore an assay that is not only economical but efficient and highly specific for HIV-1 sub type C virus. This study reports a SYBR Green-based HIV-1 real time PCR assay for viral load testing and is designed for enhanced specificity towards HIV-1 sub type C viruses prevalent in India. RESULTS: Linear regression of the observed and reference concentration of standards used in this study generated a correlation coefficient of 0.998 (p<0.001). Lower limit of detection of the test protocol was 50 copies/ml of plasma. The assay demonstrated 100% specificity when tested with negative control sera. The Spearman coefficient of the reported assay with an US-FDA approved, Taqman probe-based commercial kit was found to be 0.997. No significant difference in viral load was detected when the SYBR Green based assay was used to test infected plasma stored at -20°C and room temperature for 7 days respectively (Wilcoxon signed rank test, p=0.105). In a comparative study on 90 pretested HIV-1 positive samples with viral loads ranging from 5,000 - 25,000 HIV-1 RNA copies/ml and between two commercial assays it was found that the later failed to amplify in 13.33% and 10% samples respectively while in 7.77% and 4.44% samples the copy number values were reduced by >0.5 log value, a figure that is considered clinically significant by physicians. CONCLUSION: The HIV-1 viral load assay reported in this study was found to be robust, reliable, economical and effective in resource limited settings such as those existing in India. PCR probes specially designed from HIV-1 Subtype C-specific nucleotide sequences originating from India imparted specificity towards such isolates and demonstrated superior results when compared to two similar commercial assays widely used in India.