Autonomic Dysregulation And Low Heart Rate Variability In Spinal Cord Injury (SCI): A Marker For Depression

Background: Spinal cord injury (SCI) results in physical, autonomic, and psychological consequences. Depression is among one the most common psychological effects of SCI, with an incidence of 22%. Depression is associated with reduced heart rate variability (HRV), but it remains unclear if autonomic dysregulation possesses depression risk in SCI. Thus, this study aims to explore the association between HRV and depression in SCI. Methodology: Ninety-one spinal cord injured patients (eighty-eight males and three female) representing three levels of severity of injury (cervical, high thoracic, and low thoracic) were recruited. Basal/resting HRV was assessed using 1000Hz Polar Heart rate monitor RS800 CX and Kubios HRV software. PHQ-9 assessed the depression; a cut of 10 was used to divide the sample into patients with probable Major Depressive Disorder (MDD) and non-MDD. Results: Non-parametric tests for between-group comparisons showed a significant difference in HRV variables (p<0.05) between the probable MDD and non-MDD SCI. Significant differences in HRV were observed between the low and high thoracic (p<0.05) and low thoracic and cervical group (p<0.05), suggesting that the functioning of the autonomic nervous system might differ with level of SCI. Conclusion: Depression in SCI has been associated with injury-related factors; we use the neurovisceral theory to explain the role of the autonomic nervous system in depression in SCI.

Central Venous Catheter-related Blood Stream Infections: Incidence, Risk Factors and Associated Pathogens in a University Hospital ICU

Central Venous Catheters (CVCs) are indispensable in current intensive care treatment; also pose a greater riskof device related infections in comparison to any other type of medical device and are major cause of morbidity,mortality and increased expense. A cross sectional prospective study of one year duration was conducted inthe tertiary care University Hospital ICU located in the rural region of Haryana, India, to determine the incidenceof the central venous catheter related bloodstream infection (CRBSI), rate of catheter colonization and toidentify the associated risk factors and the microbial spectrum of CRBSI along with the antimicrobial sensitivitypattern of microbial isolates. Sixty patients with central venous catheter inserted and admitted under ICUhaving signs and symptoms of septicaemia post 48 hours of central venous catheter insertion were included.The rate of CRBSI was assessed by paired quantitative blood culture method in the CVC and peripheral vein.The CRBSI incidence was 16.67% and catheter colonization was found to be 53.3%. Methicillin-resistantstaphylococcus aureus and Acinetobacter baumanni were the predominant isolates. A statistically significantassociation of duration of catheterization with CRBSI was found. It is concluded that CRBSI incidence ishigh, with significant association of prolonged duration of catheterization with CRBSI. By knowing the changingtrends of microbial flora, empirical therapy can be formulated for early and effective management of CRBSI.

Evaluation of oral health status of 15 years old school going children in district Indore, Madhya Pradesh, India

Background: Dental caries and Gum diseases are the major public health problem in developed and developing countries both and the prevalence is more during the childhood specially in lower socioeconomic strata of our society so present study was conducted to find out the prevalence of dental and gum diseases among the 15 years of age school going children.Methods: This study was conducted among 15 years old children of government rural schools in the catchment area of Sri Aurobindo Institute of Medical Sciences, District Indore after getting ethical approval from institutional ethical committee, 400 students were included till the required sample size was achieved. Oral cavity examination was done by a team of evaluated for oral health status by a trained examiner who took training in department of community dentistry and Pedo-odontology. Data was entered and analysed by using SPSS.Results: Present study reveals that 38% of participants had dental decay out of which was more there in boys and found statistically significant <0.05. Majority of participants (70%) had normal gums only 4% had bleeding gums. 9% of the the participants had hypoplastic enemal.Conclusions: The current study explores that the dental decay is the major oral health problem followed by calculus. Oral health education and oral cavity examination should be done at a regular interval study.

​Assessment For Performance Of Middlebrook 7h9 With Oleic-Albumin-Dextrose-Catalase Culture Media For Isolation Of Mycobacterium Tuberculosis In Ziehl–Neelsen Smear-Positive Sputum Samples In Clinically Suspected Cases Of Tuberculosis

Introduction: Pulmonary tuberculosis (TB) is a second foremost cause of death from a communicable disease, after the HIV.Being communicable should be diagnosed at the earliest. Smear examination is preliminary step for the confirm diagnosis, butculture is still a gold standard method.Materials and Methods: The present study was carried out in the Department of Microbiology on a total of 600 smear sputumsamples from clinically suspected cases of pulmonary TB attending the outpatient and inpatient departments of MMIMSR,Mullana, Ambala, from December 2016 to June 2018. Specimens were subjected to ZN and LED staining before and afterdecontamination. After microscopy, specimens were subjected to culture on LJ and Middlebrook 7H9.Results: Mycobacterium tuberculosis was isolated in 23.33% of samples. 110 (78.57%) were detected by microscopy (ZN andLED), respectively. ZN smear positivity before and after decontamination was maximum in mucopurulent 78% and 76.63% andLED 73.63% and 72.03%. Culture positivity on Middlebrook 7H9 was 100% while 87.85% on LJ media. The rate of contaminationwas 5% and 7% on Middlebrook 7H9 and LJ media, respectively.Conclusions: Middlebrook media was superior to the conventional LJ medium in being rapid, easy to use and interpret, andsignificantly low time-to-growth detection and had lesser contamination rate because the liquid media contains growth supplementoleic-albumin–dextrose-catalase, provides additional nutrition.

Awareness of ultrasonography among antenatal mothers attending the tertiary care hospital in Bundelkhand region of UP

Background: Ultrasound examination during pregnancy has become an integral part of antenatal care throughout the world. This technology is an important tool for the obstetricians, to reassure their patients regarding the well-being of their fetus in utero. The objective of this study was to assess the awareness of USG among pregnant women.Methods: This cross-sectional study was carried out among pregnant women attending the ANC clinic of Obstetric department of MLB Medical College Hospital, Jhansi, UP from March to May 2018. The study included 300 pregnant women and data was collected by using pre tested questionnaire.Results: The study reveals that 51.3% of participants were in the age group of 20-25 yr and 50% of them belong to upper lower class, most of them unskilled (83.4%), 63.3% of participants depicted that USG is done only to confirm the pregnancy and 81% of women considered that it is beneficial during pregnancy and 65% was known that USG can be used to determine sex of the foetus.Conclusions: Awareness regarding the uses of ultrasonography during pregnancy was found to be average. There is need to create more awareness in community about the USG uses and PCPNDT act and its provisions. There is need of creating more awareness about the safety, utility and frequency of USG during antenatal period to avoid misuse.

Study regarding the feeding practice among mothers attending the immunisation clinic of a tertiary care centre

Background: The world health organization (WHO) recommends exclusive breast feeding (EBF) for the first six months of life while it is advised to provide adequate and safe complementary foods with breast feeding for up to two years and beyond.Methods: A hospital based cross sectional study was carried out in the immunisation clinic of IGIMS for a period of 6 months from January 2017 to June 2017.A total of 400 mothers were enrolled in the study. Children of Age group 0-12 months were included in the study. Sample size was collected by using convenient sampling from January to June 2017. All mothers who attended our immunization clinic for vaccination of their child and had children less than 12 months of age and who gave verbal consent were included in the study. Mothers were asked to stay after vaccination of their infants to look for any untoward effects of vaccination. Mothers were interviewed by using a semi structured questionnaire after getting a verbal consent from them, All data entry and analyses were carried out using Microsoft Excel and statistical software by descriptive statistics and presented as frequency and percentages.Results: The prevalence of exclusive breast feeding for up to 6 months of age was still low. Male child is having a higher percentage of immunization coverage of about 60%, where as the female child is having about 40%. 36% of the babies were started breastfeeding within one hour and colostrum was given to 40% of them, only 35% of them were on exclusive breast feeding.Conclusions: Use of expressed breast milk was low. The prevalence of EBF for up to 6 months of age was still low as per WHO recommendations. The mother's perception of “insufficient breast milk” was also the main reason for introducing other foods. We should make a strategy by making a guideline for promoting and educating about exclusive breastfeeding within the existing health care system such as the antenatal, after delivery and vaccination clinics.

Isoniazid and rifampin drug susceptibility testing: application of 2,3,5-triphenyl tetrazolium chloride assay and microscopic-observation drug-susceptibility assay directly on Ziehl-Neelsen smear positive sputum specimens

Abstract The current study was aimed to evaluate the performance of direct 2,3,5-triphenyl tetrazolium chloride assay and direct microscopic observation drug susceptibility assay with indirect Löwenstein-Jensen proportion method directly on Ziehl-Neelsen smear positive sputum specimens. Methods Direct acid fast bacilli smear positive sputum specimens (n = 264) were subjected to isoniazid and rifampicin drug susceptibility testing by direct 2,3,5-triphenyl tetrazolium chloride assay, direct microscopic observation drug susceptibility assay, and the performances were compared with indirect Löwenstein-Jensen proportion method. Results The direct 2,3,5-triphenyl tetrazolium chloride assay demonstrated an overall sensitivity, specificity, positive predictive value, and negative predictive value of 99.2%, 82.4%, 99.2%, and 88.5%, respectively, for the detection of isoniazid and rifampicin resistant Mycobacterium tuberculosis isolates when compared to indirect Löwenstein-Jensen proportion method. Likewise, the overall sensitivity, specificity, positive predictive value and negative predictive value of direct microscopic observation drug susceptibility assay were 98.8%, 82.4%, 99.2%, and 78.2%, respectively. Conclusion The direct 2,3,5-triphenyl tetrazolium chloride assay was found to be an economical alternative method for the rapid and accurate detection of isoniazid and rifampicin resistance from direct acid fast bacilli smear positive sputum specimens.

Bacterial Isolates and their Antibiotic Sensitivity Pattern in Clinically Suspected Cases of Fever of Unknown Origin.

The present study was conducted on 100 suspected cases of fever of unknown origin to identify the prevalence of predominant bacterial microorganisms and their drug sensitivity pattern. The blood samples were subjected to conventional blood culture and BACTEC 9050 culture system. Out of 100 suspected cases, culture positivity was seen in 46% cases with 80.43% pathogenic bacterial isolates comprising of 54.05% gram positive and 45.94% gram negative isolates. Predominant gram positive isolates were coagulase negative Staphylococcus 35% followed by 30% Staphylococcus aureus with sensitivity to vancomycin (100%) and resistance to ampicillin, cloxacillin & cefalexin. Gram negative isolates were Salmonella typhi (29.41%) followed by E coli (17.64%) showing sensitivity to piperacillin/tazobactum and cefoperazone/sulbactum (90%) each and resistance to amoxicillin. BACTEC 9050 was observed to be sensitive(100%) as compared to conventional blood culture(67.56%) for cultural isolation of pathogenic organisms in clinical specimens.

Extended-spectrum β-lactamase and AmpC β-lactamase Production among Gram-negative Bacilli Isolates Obtained from Urinary Tract Infections and Wound Infections.

Extended-spectrum β-lactamases (ESBLs) and AmpC β-lactamases continue to be a major problem in healthcare settings. Due to the scarcity of information regarding the antibiotic susceptibility patterns particularly from urinary tract infections (UTIs) and wound infections, the current study was carried out to assist the clinicians to prescribe appropriate antibiotics against gram-negative clinical isolates. In the current study, urine (n = 620) and pus (n = 228) samples were collected from different sites (at various clinical departments) and subjected to direct microscopic examination, culture and antibiotic susceptibility testing (AST). In the AST testings, the isolates that exhibited reduced zone of inhibition to one or more of the antibiotics such as cefotaxime (≤27 mm), ceftriaxone (≤25 mm), ceftazidime (≤22 mm), cefpodoxime (≤17 mm) and aztreonam (≤27 mm) were considered as potential ESBL producers and the ESBL production was confirmed using phenotypic screening test (doubledisk synergy test) and phenotypic confirmatory test (combined-disk test). However, isolates showing resistance or decreased sensitivity to cefoxitin, cefotaxime, ceftriaxone, ceftazidime, cefpodoxime or aztreonam and sensitive to cefepime were considered as a screen positive AmpC producer and subjected to AmpC disk tests. The current study concluded that 72.41% and 21.76% of ESBL and AmpC producers were detected, respectively in our hospital. It was also observed that the double-disk synergy and combined-disk tests were equally effective for ESBL detection. Further, AmpC disk test is simple, easy to perform and interpret, requiring less expertise for the rapid detection of AmpC isolates.

Microbiological Investigation In Dead Bodies For Prevalence of Tuberculosis.

Despite the availability of effective treatment for most cases, tuberculosis is still a cause of death in our country. Some cases of active tuberculosis are not identified until after the patient had died and an autopsy has been performed. This study was done to determine the prevalence of tuberculosis in autopsy cases.We aimed to determine the infection with Mycobacteriumtuberculosis using Tuberculosis culture in samples that were obtained from lungs of forensic cases whoseautopsies had been performed in the mortuary of our institution.In our autopsy study, out of the 168 tissue samples that were obtained from lungs over a period of three years, only 9 (5.36%) were positive for Tuberculosis in Lowenstein-Jensen medium. For this reason, we think that autopsy workers have to be carefulabout tuberculosis during their autopsy working. Awareness of tuberculosis and its high prevalence in India is essential for minimising missed diagnoses. Absence of suspicion and delayed diagnosis mean increased risk in health care and at autopsy. Although this is a burning issue but the forensic medicine departments in India seem to be taking it lightly.

Extrapulmonary Tuberculosis In M.M.I.M.S.R, Muallana Ambala: A Microbiological & Histopathological Study.

Clinical microbiological and histopathological confirmation plays a key role in the diagnosis of tuberculosis. The present study correlates Zeihl Nelson staining , Lowenstein Jensen culture media, Montoux test and histopathology in the diagnostic yield of extrapulmonary tuberculosis.Result of current study shows out of total 255 samples, 24 (9.4 %.) showed the presence of mycobacteria by either of the following methods: LJ culture media, ZN staining, histopathology and montoux test.

Pre-testing Screening for HIV before Conducting Post-mortem Examinations.

The concern about contracting an infectious disease during the course of an autopsy is great, a concern heightened when the devastating infections that could be transmitted are considered. The fear and concern, however, appear out of proportion to the actual incidence of such disease transmission. In our autopsy study, out of the total 328 blood samples tested, only 2 (0.6%) samples were found to be HIV seroreactive, over a period of three years. A comparison with similar studies abroad, reveals varied results, which do not represent the population data. However more such studies will be needed in different regions of countries to find any significant pattern or correlation. Although this is a burning issue but the forensic medicine departments in India seem to be taking it lightly. The association of the department with a microbiologist is essential in saving its staff.

Evaluation of rapid techniques for the detection of mycobacteria in sputum with scanty bacilli or clinically evident, smear negative cases of pulmonary and extra-pulmonary tuberculosis

The objective of the current study was to compare two rapid methods, the BBL Mycobacteria Growth Indicator Tube (MGIT TM) and Biotec FASTPlaque TB TM (FPTB) assays, with the conventional Löwenstein-Jensen (LJ) media assay to diagnose mycobacterial infections from paucibacillary clinical specimens. For evaluation of the clinical utility of the BBL MGIT TM and FPTB assays, respiratory tract specimens (n = 208), with scanty bacilli or clinically evident, smear negative cases and non-respiratory tract specimens (n = 119) were analyzed and the performance of each assay was compared with LJ media. MGIT and FPTB demonstrated a greater sensitivity (95.92 percent and 87.68 percent), specificity (94.59 percent and 98.78 percent), positive predictive value (94.91 percent and 99.16 percent) and negative predictive value (96.56 percent and 90.92 percent), respectively, compared to LJ culture for both respiratory tract and non-respiratory tract specimens. However, the FPTB assay was unable to detect nontuberculous mycobacteria and few Mycobacterium tuberculosis complex cases from paucibacillary clinical specimens. It is likely that the analytical sensitivity of FPTB is moderately low and may not be useful for the direct detection of tuberculosis in paucibacillary specimens. The current study concluded that MGIT was a dependable, highly efficient system for recovery of M. tuberculosis complexes and nontuberculous mycobacteria from both respiratory and non-respiratory tract specimens in combination with LJ media.

Effect of monothiol along with antioxidant against mercury-induced oxidative stress in rat.

Efficacy of thiol chelators viz. N-acetyl cysteine and D-penicillamine (NAC and DPA) along with nutritional supplements viz. zinc acetate, sodium selenite and magnesium sulphate (Zn, Se and Mg) in the treatment of mercury intoxication was investigated in rats. This is of particular interest since high bonding affinity between mercuric ion and the thiol group exits. The mutual antagonism of mercury and selenium is one of the strongest examples of the interaction in the trace element field. Adult rats of Sprague-Dawley strain were administered a bolus dose of dimethyl mercury (10 mg/kg) orally. A significant rise in the aspartate aminotransferase, alanine aminotransferase, serum alkaline phosphatase, lactate dehydrogenase, gamma glutamyltranspeptidase, bilirubin and creatinine were observed. Single mercury exposure also resulted in a significant increase in lipid peroxides with a concomitant decrease in reduced glutathione level in liver, kidney and brain. A decrease in the enzymatic activities of acetyl cholinesterase in different regions of the brain was observed. These parameters were restored considerably with chelating agents along with nutritional supplementation, but NAC+Se and DPA+Mg offered significant protection in comparison with other combinations.