Group B Streptococcal Colonization among Pregnant Women and Neonates in a Tertiary Care Hospital in South India

Objectives To assess the prevalence of maternal and neonatal group B Streptococcal colonization, incidence of neonatal systemic illness, and antibiotic sensitivity of isolates. Methods This prospective cohort study was conducted in a South Indian tertiary care hospital. Rectovaginal swabs from pregnant mothers at 360/7–376/7 wk gestation and throat and rectal swabs from their neonates at 48 h of age were collected. Presence of group B Streptococcus (GBS) was identifed by broth enrichment step, and traditional microbiologic methods and antibiotic sensitivity of isolates was noted. All mothers received intrapartum antibiotic prophylaxis (IAP). Culture-positive sepsis, clinical sepsis, pneumonia, meningitis, and urinary tract infection were defned as neonatal systemic illness. Neonates of colonized mothers were followed at 3 mo for late-onset sepsis. Results Of the 310 mothers, 40 were GBS colonized (prevalence: 12.9%; 95% CI 9.2%, 17.6%). None of the neonates were colonized. Maternal GBS colonization was signifcantly associated with premature rupture of membrane (RR - 2.93, 95% CI - 1.66–5.16) and neonatal systemic illness (RR - 2.78, 95% CI - 1.39–5.54). Positive correlation was noted between duration of IAP?4 h and neonatal illness and between maternal GBS colonization and Apgar at 1 min?4. Clindamycin resistance was noted in 20%. All neonates remained well at 3 mo follow-up. Conclusion High maternal colonization alerts the need for GBS screening in India. Clindamycin resistance among GBS isolates questions its efectiveness as alternative therapy in penicillin allergy.

Satisfaction and maternal postnatal adjustments following different modes of delivery

Background: Childbirth has a profound influence in a women’s life. One factor that has been more consistently identified as influencing the women’s physical and psychological symptoms following childbirth is the mode of birth.  This study aims at figuring out on women’s satisfaction with their mode of delivery and what difficulties they faced in the immediate postnatal period accordingly.Methods: All women who delivered between the period 1st July 2019 to 1st August 2019 were interviewed with a pretested semi structured questionnaire on postnatal day two. Patient was asked how much they were satisfied with their mode of delivery, immediate postnatal adjustments like ambulation, holding the baby first time, initiation of breastfeeding and pain score following different modes of delivery. The data was analysed to find out which mode of delivery made women more comfortable in the immediate postnatal period.Results: A total 97.1% women were satisfied with the support they got from health care professionals during labour. But when compared, spontaneous vaginal delivery group were satisfied with their mode of delivery (P-value-0.0005 highly significant) than the rest. Women who had vaginal delivery were ahead of caesarean group in terms of ambulation, holding the baby, initiation of breastfeeding and were well adjusted in their postnatal period.Conclusions: Authors conclude that women in our study were more satisfied with spontaneous vaginal delivery than caesarean section which was reflected in their immediate postnatal adjustments. As obstetricians’ authors need to understand the empowering effects of the psychological experience of vaginal delivery. The benefits of this process can be maximized through good communication skills and emotional support for women, enhancing their confidence to deliver normally so that caesarean section is done only when really indicated.

To Compare The Efficacy of Adding Clonidine Versus Adding Dexmedetomidine as an Adjunct to 0.25% Bupivacaine in Supraclavicular Brachial Plexus Block

Background: Brachial plexus blockade is a technique used for providing anaesthesia and post-operative analgesia for upper limb surgeries. Among the various approaches, supraclavicular approach is considered safest and most effective. Addition of adjuvants, not only prolongs the analgesic effect but also improves the quality of anaesthesia. Aim And Objectives –The study was undertaken to compare between Clonidine and Dexmedetomidine as adjuvants to 0.25% Bupivacaine in Supraclavicular Brachial Plexus block. Methods: The study was conducted in Gandhi Hospital, Secunderabad after obtaining approval from institutional ethical committee and written informed consent from each patient. Sixty patients aged 18-50 years undergoing upper limb surgeries were included in the study. Patients were randomly divided into two groups of 30 patients each. Group C (Clonidine) – received conventional supraclavicular brachial plexus block with 40 ml of 0.25% Bupivacaine and 0.5 μg/kg of Clonidine. Group D (Dexmedetomidine) – received conventional supraclavicular brachial plexus block with 40ml of 0.25% Bupivacaine and 0.5 μg/kg of Dexmedetomidine. The onset of sensory and motor blockade were noted. Intra-op haemodynamics, post-op pain and side effects were assessed at regular intervals. Results: The duration of analgesia is prolonged with Dexmedetomidine as compared to Clonidine with no significant difference either in onset of sensory and motor blockade or in hemodynamic variables. The only side-effect observed was hypotension in Clonidine group. Conclusion: We conclude that Dexmedetomidine has prolonged duration of analgesia with no side effects as compared to Clonidine.

A Comparative Study of Dexmedetomidine Infusion Vs Clonidine Infusion in Maintaining Intra Operative Haemodynamic Stability and Post Op Analgesia Requirment in Laparoscopic Cholecystectomy

Background: Laparoscopic surgery has become the choice for many procedures owing to it’s minimally invasive technique. This not only reduces the post-operative stress, but also improves the overall outcome. However, it is associated with its own complications. Various drugs have been used to counter the haemodynamic fluctuations caused by laparoscopic surgery. α2 agonists have shown good results when used intraoperatively. Aim and Objectives –1 )To compare between inj.Clonidine and inj.Dexmedotamine in attenuation of stress response and haemodynamic stability intra operatively in laparoscopic surgeries. 2) To compare between the analgesia requirement between inj.Clonidine and inj.Dexmedotamine during post-operative period in laparoscopic cholecystectomy surgery. Methods: After obtaining approval from institutional ethical committee and written informed consent from each patient. Sixty patients aged 20-50 years undergoing laparoscopic cholecystectomy were included in the study. Patients were randomly divided into two groups of 30 patients each. Group C (Clonidine) received inj. clonidine 150 μg and group D received inj.dexmedetomidine 150 μg iv in 100ml NS 30 minutes before induction of anaesthesia. Intra-op haemodynamics, post-op pain and side effects were assessed at regular intervals. Results: Dexmedetomidine being a α2 receptor agonist decreases or inhibits the release of the catecholamines and vasopressin. Dexmedetomidine by its sedative, anxiolytic, and analgesic properties, provides a good haemodynamic control and decreased analgesic requirement postoperatively when compared with Clonidine. Conclusion: We conclude that Dexmedetomidine provides a good haemodynamic control and good analgesia when compared to Clonidine in laproscopic cholecystectomy procedures with good monitoring.

Undernutrition & tuberculosis in India: Situation analysis & the way forward.

Undernutrition and tuberculosis (TB) are linked and have a bidirectional relationship. Undernutrition increases the risk of TB which in turn, can lead to malnutrition. Undernutrition not only is a risk factor for progression of latent TB infection to active disease, but also increases the risk of drug toxicity, relapse and death once TB develops. The dietary intake of TB patients in the country is inadequate. Nutritional supplementation in patients with TB is associated with faster sputum conversion, higher cure and treatment completion rates, significant gain in body weight and body composition as well as better performance status. The Government of India has various social support schemes (including nutrition supplementation schemes) and policies, at the Centre as well as State levels. Here we discuss some successful examples and suggest a few solutions to address this gap; like considering TB patients as a vulnerable group for “Targeted Public Distribution System” and providing extra rations for the duration of treatment. Recommendations for the research community, civil societies, government organizations, non-governmental and corporate sector on the actions needed to achieve the goals of the End TB Strategy are also provided. Ultimately, reduction of TB burden in India and its elimination will require improving the nutritional status of the community as a whole.

Reliability of involving community volunteers as DOT providers in DOTS strategy under RNTCP.

Set up: One Tuberculosis Unit (TU) in Tiruvallur district, Tamil Nadu, where Tuberculosis (TB) patients treated under Directly Observed Treatment Short Course (DOTS) programme. Objective: To assess the reliability and accountability of Government health workers and community volunteers as DOT Providers (DPs) and to assess treatment outcome and problems encountered by patients managed by different DPs and the acceptability of community providers in the RNTCP. Methods: The 189 DPs in the study area during the first and second quarters of 2005 and 303 patients who were treated by these DPs were interviewed. Univariate analyses were used to identify the factors influencing the success rate. Results: Of 303 patients treated, the success rates of the patients treated by Government DOT providers (GDP) and community DOT providers (CDP) were 85.3% (209/245) and 86.2% (50/58) respectively. The difference in the success rates by GDP and CDP was not statistically significant. Among the 259 patients who successfully completed treatment, 82% (172/209) under GDP and 84% (42/50) under CDP were regular for treatment and there was no association between the type of DOT providers and regularity of treatment. Conclusion: Community volunteers could be inducted as DPs into the DOTS strategy for efficient supervision and management of the patients.

Carbon isotope fractionation studies of bacterial strain Rhodococcus rhodochrous MTCC 291.

Carbon isotope fractionation associated with the aerobic consumption of propane (C3) were determined using Rhodococcus rhodochrous MTCC 291 bacterial strain to estimate the amount of hydrocarbon oxidized using GC, fractionation of δ13C carbon isotopes of propane and CO2 using GC-C-IRMS and growth of bacteria by UV-Visible Spectrophotometer. The initial δ13C isotopic value of propane was -34 ‰ and after incubation the changes of the isotopic values have been determined on 6th, 10th, 14th, and 17th days. The propane isotopic fractionation value was found to be maximum of -38.0 ‰ with an average value of -36.5 ‰ and a standard deviation of -1.22 ‰. The initial δ13C isotopic value of CO2 was -19.601 ‰. The CO2 isotopic fractionation value was found to be maximum of -29.153 ‰ with an average value of -26.859 ‰ and a standard deviation of -28.338 ‰. The consumption of propane gas was estimated using Gas Chromatograph. The initial concentration of propane in control was found to be 53 ppm. On incubation, the consumption of the propane gas was observed to be of 26 ppm. The carbon isotope fractionation presented here may be applied to estimate the extent of C1-C4 oxidation in natural gas samples, and should prove useful in further studying the microbial oxidation of these compounds in the natural environment.

Evaluation of potable groundwater quality in some villages of Adilabad in Andhra Pradesh, India.

Reconnaissance hydrochemical survey was conducted in some villages of Adilabad district, Andhra Pradesh to assess the quality of groundwater, which is mainly used for drinking purpose. The study consists of the determination of physico-chemical properties, trace metals, heavy metals and rare earth elements in water samples. The data showed the variation of the investigated parameters in samples as follows: pH 6.92 to 8.32, EC 192 to 2706 µS cm-1, TDS 129.18 to 1813.02 ppm. The pH of the waters was within the permissible limits whereas EC and TDS were above the permissible limits of World Health Organization (WHO). Total 27 elements (Li, Be, B, Na, Mg, Al, Si, K, Ca, V, Cr, Mn, Fe, Ni, Co, Cu, Zn, As, Se, Rb, Sr, Mo, Ag, Cd, Sb, Ba and Pb) were analyzed using Inductively Coupled Plasma-Mass Spectrometer (ICP-MS). The concentration of elements in water samples ranged between 0.063 to 0.611 mg l-1 for B, 11.273 to 392 mg l-1 for Na, 5.871 to 77.475 mg l-1 for Mg, 0.035 to 1.905 mg l-1 for Al, 0.752 to 227.893 mg l-1 for K, 11.556 to 121.655 mg l-1 for Ca and 0.076 to 0.669 mg l-1 for Fe respectively. The concentrations of Na, Mg, Al, K, Ca, and Fe exceeded the permissible limits of WHO and BIS guidelines for drinking water quality. In the present study, Bhimavaram, Kazipalli, Kannepalli and Chennur areas of the Adilabad are especially prone to geogenic contamination. Overall water quality was found unsatisfactory for drinking purposes.

Characterization of light gaseous hydrocarbons of the surface soils of Krishna-Godavari basin, India.

Several techniques are used for the exploration of hydrocarbons, of which; the geochemical techniques involving the microbiological technique use the principle of detecting the light hydrocarbon seepage activities for indication of sub-surface petroleum accumulations. A survey was carried out to characterize the light gaseous hydrocarbons seeping in oil and gas fields of Krishna-Godavari basin of Andhra Pradesh. A set of 50 sub-soil samples were collected at depths of about 3 m for geochemical analyses and 1m for microbiological analysis. The microbial prospecting studies showed the presence of high bacterial population for methane 2.5 x 102 to 6.0 x 106 cfu g-1, propane 1x102 to 8.0 x 106 cfu g-1 in soil samples. The adsorbed soil gas analysis showed the presence of moderate to low concentrations of methane (26 to 139 ppb), ethane (0 to 17 ppb), propane (0 to 8 ppb), butane (0 to 5 ppb) and pentane (0 to 2 ppb) in the soil samples of the study area. Carbon isotope analysis for methane (´13C1) ranging from -36.6 to -22.7‰ Pee Dee Belemnite (PDB) suggests these gases are of thermogenic origin. Geo-microbial prospecting method coupled with adsorbed soil gas and carbon isotope ratio analysis have thus shown good correlation with existing oil/ gas fields of Krishna-Godavari basin.