'Health, Environment and Training': Guidance on conduct of physical exertion in hot and humid climates.

BACKGROUND: Military operations and training in hot environments present a special set of challenges to medical personnel who must support them. METHODS: Various meteorological parameters such as relative humidity (RH), ambient air temperature (Ta) and radiant temperature (Tg), were evaluated at training sites in a desert region. Development of a colour coded Heat Stress Prevention Decision Aid Tool was done using an existing guideline chart. RESULTS: Temperatures were being recorded routinely by ordinary meteorological instruments mounted within a Stevenson Screen. Onsite measurements with a USB datalogger was found to be relevant in making a decision on suitability of weather for conduct of training. Heat casualties occur when the stresses imposed by some combination of environment, work, and clothing combine to exceed individual tolerance limits. Personnel may encounter high environmental heat loads while working outdoors; during road marches; and while carrying loads or undertaking mechanical maintenance activities. Preventive strategies cannot be expected to eliminate heat stress but should minimize its impact on training while preserving the health of personnel to the extent possible. CONCLUSION: It is recommended that onsite measurement of meteorological parameters should be done, and a decision tool should be utilized for arriving at a spot decision by junior leaders.

Wishing away Plagiarism in Scientific Publications! Will it work? A situational analysis of Plagiarism policy of journals in PubMed.

BACKGROUND: Plagiarism remains a scourge for the modern academia. There are inconsistencies in the plagiarism policy scientific journals. The aims of this study was to analyze types of published articles on 'Plagiarism' available on PubMed over last two decades against a backdrop of the plagiarism policy of the journals publishing such articles. METHODS: A literature search on PubMed (https://www.ncbi.nlm.nih.gov/pubmed) was made using the search term "plagiarism" from 01 January 1997 till 29 March 17. All publications having 'plagiarism' in the title formed the study group. The following were noted: types of articles published, ethical and plagiarism policy of the journal as available in the Instructions to authors and or in the journal home page. RESULTS: A total of 582 publications from 320 journals were studied. Editorials (165, 28.3%) and Letters to the Editor (159, 27.3%) formed the bulk. Research articles (56, 9.6%), Review articles (51, 8.7%) and Commentaries (47, 8%) formed the remainder. Detailed ethical guidelines were present in 221 (69%). Outline ethical guidelines only were present in 15 (4.7%) journals. 49 (15.3%) journals did not have any ethical guidelines. Detailed description of the policy on plagiarism was found in 80 (25%) journals. Only an outline description was found in 29 (9%) journals while a plagiarism policy/statement was totally absent in 176 (55%) journals. CONCLUSION: There is a need to have a well defined plagiarism policy/statement for all scholarly journals easily visible on their home pages on the internet and also in their Instructions to Authors.

Filaria surveys in the Armed Forces: Need for a revisit.

BACKGROUND: Routine annual filarial surveys are conducted amongst various categories of military personnel and their families as per policies in vogue in the Armed Forces. The neglect and inattention faced by this disease needs to be addressed in terms of policy, provisioning and processes while dealing with filariasis in the Armed Forces. METHODS: Routine annual filarial survey was conducted in a garrison during the months of Nov and Dec in 2013 and 2014. Blood slides from 6305 and 10,162 persons were collected in 2013 and 2014 respectively. 546 (60.66%) civilian migratory labourers were also subjected to the filarial survey. RESULTS: Of the blood slides collected amongst service personnel, 41 were positive for mf in 2013 and 29 in 2014 (i.e. a slide positivity rate (SPR) of 0.65% and 0.28% respectively). Out of 546 blood slides of the migratory population, 10 were found mf positive (SPR 1.83%) and three males had lymphedema. CONCLUSION: It is recommended that routine annual filarial survey conducted in military garrisons should include all personnel belonging to known endemic states. Newer modalities of detection of infection may be considered to replace night blood surveys. An organization-specific surveillance programme on prevention and control of Lymphatic filariasis in the Armed Forces thus may need to be launched so that we can achieve elimination.

Blood culture isolates and antibiogram of Salmonella: Experience of a tertiary care hospital.

BACKGROUND: Enteric fevers contribute majorly to the burden of morbidity from infectious diseases in the developing world. Due to growing antibiotic resistance seen in their management, Salmonella and its various species are required to be periodically tested for sensitivity and resistance patterns, to guide the clinical management at the local level. This will also enable planning of antibiotic recycling wherever feasible. METHODS: A retrospective study of the results of blood culture isolates covering a period of 27 months was done at a tertiary care hospital. Blood samples were directly inoculated in Bactalert culture bottles and sub culture was done on Mac Conkey and Salmonella-Shigella Agar. Non-lactose fermenting colonies were processed for identification, antibiotic sensitivity and MIC value. Slide agglutination test using specific antisera was also done to confirm the serotype. Antimicrobial susceptibility was done in accordance with CLSI standards. RESULTS: 8413 blood samples were processed and 1027 (12.20%) were assessed as 'culture positive'. Salmonella were isolated in 46 samples of which 38 (83%) were Salmonella typhi and a single isolate was Salmonella paratyphi B. S.typhi showed maximum sensitivity to imipenem (100%) (MIC <0.25 µg/ml) followed by ciprofloxacin (76.8%) (MIC >1 µg/ml) and nalidixic acid (50%) (MIC ≥ 32 µg/ml). S. paratyphi B showed 100% sensitivity to all the common antibiotics. Four samples (8%) were classified as multi drug resistant (MDR). CONCLUSION: Our study has shown improved sensitivity to ceftriaxone and cotrimoxazole. A high degree of susceptibility to ampicillin among both S. typhi and S.paratyphi A is encouraging. However, low susceptibility to nalidixic acid and ciprofloxacin is a cause for concern. There is a need for further clinical studies to evaluate the response to chloramphenicol in MDR cases and to formulate uniform laboratory guidelines to test antibiotic sensitivity of S. typhi isolates.

To publish and perish: A Faustian bargain or a Hobson's choice.

As a matter of career choice, doctors have to choose between becoming an 'academic' or a 'practitioner.' To conduct research and publish articles in scientific journals is compulsory for the academic professional and mostly optional for the latter. The Medical Council of India has revised the eligibility qualifications for medical teachers over the past decade, and has now come out with regulations for streamlining the process of promotion by focusing on scientific papers, apart from clarifying on required experience and qualifications. 'Predatory publishers' are proliferating across the world, exploiting the reach of the Internet, and are enticing naïve professionals to publish their research work with them. The pitfalls of paid publishing in such journals may tarnish upcoming careers if doctors are not cautious. For a price, there are many publishers who will process articles without even rudimentary peer review; and for the sake of padding up of the resume, this Faustian bargain may eventually prove detrimental to authors, and thus with their professional credibility at stake, may prove to be a Hobson's choice. It is suggested for authors to make a wise choice and a correct decision when selecting a journal to submit their manuscripts.

Improving medical stores management through automation and effective communication.

BACKGROUND: Medical stores management in hospitals is a tedious and time consuming chore with limited resources tasked for the purpose and poor penetration of Information Technology. The process of automation is slow paced due to various inherent factors and is being challenged by the increasing inventory loads and escalating budgets for procurement of drugs. METHODS: We carried out an indepth case study at the Medical Stores of a tertiary care health care facility. An iterative six step Quality Improvement (QI) process was implemented based on the Plan-Do-Study-Act (PDSA) cycle. The QI process was modified as per requirement to fit the medical stores management model. The results were evaluated after six months. RESULTS: After the implementation of QI process, 55 drugs of the medical store inventory which had expired since 2009 onwards were replaced with fresh stock by the suppliers as a result of effective communication through upgraded database management. Various pending audit objections were dropped due to the streamlined documentation and processes. Inventory management improved drastically due to automation, with disposal orders being initiated four months prior to the expiry of drugs and correct demands being generated two months prior to depletion of stocks. The monthly expense summary of drugs was now being done within ten days of the closing month. CONCLUSION: Improving communication systems within the hospital with vendor database management and reaching out to clinicians is important. Automation of inventory management requires to be simple and user-friendly, utilizing existing hardware. Physical stores monitoring is indispensable, especially due to the scattered nature of stores. Staff training and standardized documentation protocols are the other keystones for optimal medical store management.

Klebsiella oxytoca: An emerging pathogen?

Klebsiella oxytoca is emerging as an important bacterial isolate causing hospital-acquired infection in adults and having multiple drug resistance to commonly used antibiotics. We analysed our data to observe the current pattern of drug resistance among K. oxytoca isolated from various samples during the period from January 2012 to March 2014 at a tertiary care hospital. A total of 17,335 samples were processed at the hospital laboratory during this period. Klebsiella was isolated from 654 of these clinical samples. Out of these Klebsiella species, 631 (96.48%) were K. pneumoniae and 23 (3.52%) were K. oxytoca. All the K. oxytoca isolates were sensitive to colistin and tigecyclin. However, these isolates showed 58% resistance to imipenem and meropenem. The resistance to gentamicin, amikacin and ceftriaxone was higher at 72%. Resistance to ciprofloxacin and aztreonam was less (58%). All the samples were from patients admitted to ICUs of a tertiary care centre. The data from our study show an increasing burden of infection caused by this bacterium, which is now gaining access to ICUs. It is recommended that Hospital Infection Control Committees must keep a close watch on the antibiotic pattern of K. oxytoca for better patient care.

Drug sensitivity pattern of various Staphylococcus species isolated at a tertiary care hospital.

BACKGROUND: Staphylococcus aureus and other Staphylococcus species are important pathogenic organisms and are responsible for various hospital infections. These are the predominant organisms found in pus and blood culture isolates. Infections arising due to these bacterial isolates are difficult to treat because of developing multidrug resistance. METHODS: Over a 1-year period at a tertiary care hospital laboratory, 524 Staphylococci species were isolated from pus, blood and urine samples and species-level identification was done. RESULTS: S. aureus formed the predominant species (70.8%) followed by coagulase-negative Staphylococcus (CoNS) (29.20%). S. aureus (91%) was the main isolate from pus samples; however, CoNS was isolated in equally higher proportion in blood culture (63.58%). Among the CoNS, Staphylococcus hemolyticus was the main isolate (9.3%). ß-Lactamase production, alteration of PBP and MLSB resistance were seen in variable degrees in different species. CONCLUSION: CoNS group of Staphylococci is becoming an important cause of infection at tertiary care centres. The increased multidrug resistance among various Staphylococcus species is a cause of great concern and requires adequate measures to prevent the spread of these microorganisms in the hospital and the community.

Kumbh Mela 2013: Healthcare for the millions.

Mass gatherings pose challenges to healthcare systems anywhere in the world. The Kumbh Mela 2013 at Allahabad, India was the largest gathering of humanity in the history of mankind, and posed an exciting challenge to the provision of healthcare services. At the finale of the Mela, it was estimated that about 120 million pilgrims had visited the site. Equitable geospatial distribution of adhoc health care facilities were created on a standardised template with integrated planning of evacuation modalities. Innovative and low cost response measures for disaster mitigation were implemented. Emergency patient management kits were prepared and stocked across the health care facilities for crisis response. Dynamic resource allocation (in terms of manpower and supplies) based on patient volumes was done on a daily basis, in response to feedback. An adhoc mega township created on the banks of a perennial river (Ganga) in the Indian subcontinent for accommodating millions of Hindu pilgrims. Conventional mindset of merely providing limited and static healthcare through adhoc facilities was done away with. Innovative concepts such as riverine ambulances and disaster kits were introduced. Managing the medical aspects of a mass gathering mega event requires allocation of adequate funds, proactive and integrated medical planning and preparedness.

Seroprevalence of TORCH infections in antenatal and HIV positive patient populations.

BACKGROUND: The TORCH (Toxoplasma gondii, Rubella, Cytomegalovirus (CMV) and the Herpes Simplex Virus) cause range of diseases in pregnant women and HIV patients and lead to adverse fetal outcomes when not treated on time, in HIV positive can cause life threating infections. There is inadequate data available of these infections in India. METHODS: A retrospective study was undertaken to determine the seroprevalence of the TORCH infections in antenatal and HIV/AIDS patients at a tertiary care centre. The laboratory data pertaining to the period Jan 2012-May 2014 was analyzed. The study population involved 162 antenatal cases and 729 HIV/AIDS patients under review at an ART centre. Laboratory testing was done for the presence of IgM and IgG antibodies against the TORCH infections by ELISA method. RESULTS: Among the antenatal cases, 30 (18.52%) samples were found to be seropositive for Toxoplasma IgM, CMV IgM antibodies were found in 47 (29.01%) samples, HSV IgM antibodies were found in 12 (7.40%) samples, Rubella IgM antibodies were found in 13 (8.02%) samples, indicating recent infection. Among the HIV/AIDS cases, indicative of recent or current infection, 160 (21.94%) samples were positive for Toxoplasma IgM, CMV IgM was found in 99 (13.58%), HSV IgM antibodies were found in 98 (13.44%) and Rubella IgM in 47 (6.44%). CONCLUSIONS: The study showed a high seroprevalence of the infections caused by the TORCH complex amongst pregnant women and HIV/AIDS patients despite improved hygiene conditions and health awareness. Maximum seroprevalence for CMV was observed followed by Rubella and HSV infection.

Dengue in the deserts: Search and Destroy Operations.

Dengue, a viral disease transmitted by the Aedes mosquito has the potential to cause outbreaks in urban settings. Planned and coordinated actions including entomological surveillance need to be undertaken at the community level, through synergized efforts by all partners and stakeholders. The experience of conducting such a Task Force based action plan for prevention and control of dengue, in a desert township is highlighted in this study.

Epidemiological Differentials of Hepatitis B Carrier State in the Army : A Community Based Sero-epidemiological Study.

BACKGROUND: Most available studies on seroprevalence of Hepatitis B in the Armed Forces and also at the national level are based on hospital patients and blood donors. Hence, there was a perceived need to undertake a seroepidemiological study on an adequately large and representative random sample of the general cross section of Army personnel, with a view to obtain the exact picture of the frequency and distribution of HBV in the Army. METHODS: A community based cross sectional study with random samples from four groups were drawn, viz recruits from the Army Medical Corps (AMC) and other Arms and Services; AMC personnel and personnel from other Arms and Services who had served for more than 10 years. A structured pretested questionnaire was administered to all participants and blood samples were drawn aseptically subsequently, with separation of serum and testing by ELISA technique for HBsAg. Multivariate analysis using multiple logistic regression procedure was done after appropriate data entry. RESULTS: The overall seroprevalence was 7.9% (95%CI = 6.5% to 9.26%). The differential seroprevalence in the four groups being 7.72%, 7.92%, 8.28% and 7.75% respectively. There was statistically no significant difference as regards the seroprevalence levels [p > 0.05]. As regards serving medical personnel, the seroprevalence was observed to be higher among personnel involved in direct nursing care. On multiple logistic regression analysis, two risk factors emerged as independent and significant predictors of hepatitis B positivity. These were history of sexual exposure with commercial sex workers (CSWs) (OR = 3.06, p < 0.01) and history of having taken injections from civil sources (OR = 1.92, p < 0.001). CONCLUSION: The relatively high level of seroprevalence among recruits has led to certain recommendations on testing and further studies in specific groups, based on the findings of the study.