The human gut resistome: Current concepts & future prospects

The human gut is home to a myriad of organisms. While some are harmless commensals, others are transient, pathogenic flora. The gut microbiome is composed of diverse bacterial flora, and apart from playing a major role in protecting from various infectious and non-infectious diseases, it plays an important role in resistance to antimicrobials. The collection of genes or genetic material that confers antimicrobial resistance constitutes the gut resistome, and it may involve the pathogens or commensals of the intestinal tract. The diversity of this gut resistome is influenced by various environmental factors including the diet and antibiotic exposure. This review highlights the recent concepts pertaining to the human gut resistome, factors affecting it, how it impacts human health and diseases, methods to study the resistome and potential therapeutic approaches.

Systematic Evaluation of Published Research Studies Conducted Among Medical Undergraduate Students on Learning Environment in Medical Colleges of India Using the DREEM Inventory Tool

Objective: To evaluate original studies conducted among medical undergraduate students to assess education and learning environment in India using DREEM (Dundee Ready Educational Environment Measure) tool. Material & Methods: The online search engine PUBMED and Google scholar were utilized to short list original published research studies on learning environment. The eligibility criteria included: study conducted in India upon medical students using DREEM tool; information on sample size, total, and sub-domain DREEM score available. Fourteen original research publications with a total sample size of 4215 medical students were considered. Results: Total DREEM score (range, 0-200) was 119.5 that indicated that there was more positive education environment in selected medical colleges of country. The average score of different sub domains of DREEM also supported the positive environment. Sub-domain DREEM mean scores derived through this analysis was SPL-28.7 (range, 0-48); SPA-28.4 (range, 0-48); SPT-25.8 (range, 0-44); SASP-20.2 (range, 0-32); and SSSP-16.4 (range, 0-28). The scores of all the studies were in the similar range except two. Mean score of most (80%) of the items (40/50) lied between 2 and 3 (range, 0-4) indicating that these areas were ‘neither strong nor weak’ but could be ‘enhanced’. Some aspect of the learning and education environment with average score of less than 2 include inherent challenges of the extensive medical course; the teaching over-emphasizes factual learning (item-25); students are able to memorize all the matter (item-27); and rarely feel bored (item-14) require attention. However, issues like teaching is too teacher centered (item-48); the teachers are authoritarian (item-9); and the teachers get angry in class (item-39) requires sensitization and introspection by the esteem faculty members. Conclusion: Overall students perceived progressive and positive developmental milieu in the learning environment in the selected medical colleges of India.

Comparison of Health status among married and unmarried girls of late adolescent age in an urban slum of Delhi

Background: Late adolescent girls are being forced into marriage and the burden of marital responsibilities, most notably partner’s sexual demands and childbearing and child-rearing, led to significant emotional distress and depression. Thus, early marriage for girls might have profound impact on their health status. Aims & Objectives: To study impact of early marriage on health status of married girls of late adolescent age and to compare them with unmarried girls of same age. Material & Methods: A comparison study was conducted among girls of late adolescent age in an urban slum of North East Delhi. One sixty study participants were included in each group. A pretested interview schedule was used for collecting details such as knowledge on reproductive health, physical parameters and anemic status. Chi square tests were used and odds ratio was calculated. Results: Majority of married girls, 102(63.8%) had middle school education while 93(58.1%) of unmarried girls had high school education. The mean (SD) age of marriage of married adolescent girls was 17(±) years while their husband age at time of marriage was 21.6(±) years. Levels of hemoglobin were low in both groups 87.5% in married girls and 98.75% in unmarried girls. Conclusion: Early marriage was found to have impact on menstruation, reproductive health and nutritional status of adolescent girls.

Antimicrobial resistance in the environment: The Indian scenario

Antimicrobial resistance (AMR) continues to pose a significant public health problem in terms of mortality and economic loss. Health authorities of several countries including India have formulated action plans for its containment. In this fight against AMR, it is important to realize the contribution by all the following four spheres: humans, animals, food and environment. This review incorporates all the spheres of One Health concept from the Indian perspective. India has one of the highest rates of resistance to antimicrobial agents used both in humans and food animals. The environment, especially the water bodies, have also reported the presence of resistant organisms or their genes. Specific socio-economic and cultural factors prevalent in India make the containment of resistance more challenging. Injudicious use of antimicrobials and inadequate treatment of waste waters are important drivers of AMR in India. Use of sludge in agriculture, improper discard of livestock animals and aquaculture industry are considered AMR contributors in other countries but Indian data regarding these are lacking. Efforts to combat AMR have been initiated by the Indian health authorities but are still at preliminary stages. Keeping in view the challenges unique to India, future directions are proposed.

Effect of mobile phone overuse on health of medical students

Background: In this modern era of the 21st century, mobile phones have undoubtedly been part and parcel of our lives as it has revolutionized our lifestyle. We can communicate with one another, retrieve information about education, and can use it for entertainment purpose. However, like all other good things, mobile phone also comes with its own demerits such as it causes various health hazards ranging from insomnia, numbness of fingers, irritability to headache, anxiety, and dreadful addiction. Objectives: The aim and objective of this study were to assess adverse health effects of mobile phone use among medical students in a government medical college. Materials and Methods: The study was conducted among the medical students in Murshidabad Medical College, West Bengal. A pre-designed, pre-tested, anonymous questionnaire was used to assess the mobile use pattern among the students. Results: All the students were using mobile with 28% using it for more than 6 h every day. 43% of students experienced medical problems with majority complained a lack of concentration. Duration of the use of mobile phones was significantly associated with the development of health problem. Conclusion: With increased risk of health problems associated with excessive mobile use, one should emphasize on reserving the use of cell phones for shorter conversations and other healthy modes of entertainment.

Improved detection of Shigella using Escherichia coli medium enrichment: Polymerase chain reaction from stool samples.

Laboratory diagnosis of shigellosis using conventional culture technique is limited by lower sensitivity and higher turnaround time. Here, we have evaluated the role of polymerase chain reaction from stool samples after enrichment in Escherichia coli medium for detection of Shigellae. The technique not only increased the sensitivity but also decreased the turnaround time.

Free living amoebae in water sources of critical units in a tertiary care hospital in India.

Background: Isolation of free‑living amoebae (FLA) is reported sparsely from water taps, ventilators, air conditioners, haemodialysis units and dental irrigation systems of hospitals worldwide. Their prevalence in hospital environment especially in wards having immunocompromised patients may pose a risk to this group of susceptible population as they may cause disease themselves or may carry pathogens inside them. No study from India has performed such surveillance. Objective: To evaluate extent of FLA contamination in water sources of bone marrow transplant (BMT) intensive care unit (ICU), transplant ICU, haemodialysis unit and high dependency unit in a tertiary care hospital in India. Materials and Methods: A total of hundred samples including fifty each of tap water samples and swabs from mouth of taps used for drinking, bathing and hand washing purposes in these units were collected according to standard procedure. Samples were inoculated onto non‑nutrient agar plates at room temperature followed by morphological confirmation. Molecular identification including polymerase chain reaction (PCR) and sequencing was performed in culture positive samples. Results: Four tap water samples and ten swab samples showed growth of trophozoites and cyst formation. Morphologically, four amoebae resembled Acanthamoeba spp. which was further confirmed by PCR and sequencing showed them to be of T3 and T4 genotypes. Conclusion: The presence of these FLA in hospital water sources emphasises the urgent need of implementing effective preventive measures. Further studies are required to estimate the true prevalence of FLA in Indian hospitals by taking larger number of samples.

Pyonephrosis due to Chryseobacterium gleum: A first case report.

Chryseobacterium spp are widely distributed in nature but data of their isolation from clinical samples is scanty. Here, we report the first case of AmpC producing C. gleum causing pyonephrosis in a patient having bilateral nephrolithiasis on double J (DJ) stent. The present isolate was resistant to vancomycin, erythromycin, clindamycin, carbapenems and ciprofloxacin and susceptible to tetracycline and minocycline. The patient was treated with tetracycline and recovered without the need for removal of the DJ stent. The environmental surveillance carried out to trace the nosocomial origin of the isolate was negative. Since antimicrobial susceptibility of this isolate is different from previous reports, we emphasise that in vitro susceptibility testing should be sought to choose optimal antimicrobial agents for these Nonfermentative Gram-Negative Bacilli (NFGNBs) with different susceptibility patterns.

Utility of whole‑cell repetitive extragenic palindromic sequence‑based PCR (REP‑PCR) for the rapid detection of nosocomial outbreaks of multidrug resistant organisms: Experience at a tertiary care center in North India.

Background: There is a huge need to develop molecular typing methods which are simple to perform, rapid and cost effective to confirm clonality of nosocomial isolates in outbreak situations. Objectives: The aim of the study was to investigate a hospital outbreak of multi-drug resistant (MDR) Klebsiellapneumoniae septicemia in a paediatric surgery intensive care unit (PSICU) using a repetitive extragenic palindromic polymerase chain reaction (REP‑PCR). Materials and Methods: MDR Klebsiella pneumoniae isolates from an outbreak of nosocomial sepsis were typed byREP‑PCR using consensus primers. Isolates from different intensive care units (ICUs) but with similar antibiogram were also genotyped for comparison. Results and Conclusion: A cluster of twelve MDR K Pneumoniae septicemia cases was identified at the PSICU by genotyping using REP‑PCR. Surveillance cultures failed to pick up any source of infection. REP‑PCR was found to be a rapid and simple tool for investigation outbreaks in hospitals. Due to early detection we could initiate infection control practices with focus on hand washing and prevent the further transmission of the organism.

Imipenem resistance in nonfermenters causing nosocomial urinary tract infections.

Nonfermenting gram-negative bacilli (nonfermenters) have emerged as important nosocomial pathogens causing opportunistic infections in immunocompromised hosts. These organisms show high level of resistance to b-lactam agents, fluoroquinolones and aminoglycosides. Imipenem is a carbapenem antibiotic, which can be very useful for treatment of infections caused by nonfermenters. Eighty-five nonfermenters causing nosocomial UTI were tested for MIC to imipenem by agar dilution method. Resistance to other antimicrobial agents was compared between imipenem sensitive (S) and resistance (R) groups. Overall 36.4% of nonfermenters were resistant to imipenem. Forty two percent of P. aeruginosa and 18.5% of Acinetobacter baumanii were imipenem resistant. Other nonfermenters showed variable resistance, resistance in Alcaligenes spp. being very high. More than 70% of the nonfermenters were resistant to ceftazidime, gentamicin and ciprofloxacin. Piperacillin and amikacin had the best in vitro susceptibility. No significant difference was found in the antibiotic susceptibility profile among imipenem sensitive (S) or resistant (R) strains.

Prevention of postoperative infections in ophthalmic surgery.

Postoperative endophthalmitis is a serious, vision-threatening complication of intraocular surgery. Better instrumentation, surgical techniques, prophylactic antibiotics and better understanding of asepsis have significantly reduced the incidence of this complication. Postoperative endophthalmitis may occur as an isolated event or as a cluster infection. Topical antibiotics, preoperative periocular preparation with povidone-iodine combined with a sterile operating room protocol significantly reduce the incidence of isolated postoperative endophthalmitis. The role of antibiotics in the irrigating fluid and subconjunctival antibiotics remains controversial. Cluster infections on the other hand are more likely to occur due to the use of contaminated fluids/viscoelastics or a breach in operating room asepsis. Prevention of postoperative endophthalmitis requires strict adherence to operating room norms, with all involved personnel discharging their assigned roles faithfully.

Dermatoglyphic patterns of patients with rheumatoid arthritis.

Finger tip and palmar dermatoglyphics were studied in 31 patients (22 females and 9 males) with rheumatoid arthritis (RA) and 38 matched controls (20 females and 18 males) from North India. While not many differences were observed in palmar patterns, a low ending of line A was found on both hands of two patients. Finger tip patterns were significantly different in patients compared to controls. No association with any dermatoglyphic feature and HLA antigens was observed.

Induction of sister chromatid exchanges in phenytoin treated & untreated patients with epilepsy.

The mutagenic potential of phenytoin (PHT) was studied using the sister chromatid exchange (SCE) assay. Twenty nine PHT treated epileptics, 32 untreated and 32 normal healthy controls were analysed. Similar SCE frequencies were observed in untreated patients and patients on PHT monotherapy. Both groups had significantly increased SCE frequency as compared to controls. No positive correlation of SCE frequency with sex and duration of therapy was observed. The results of the present study suggest the role of the disease condition in inducing genetic damage as assessed by increased SCE frequencies.