Application of WHONET for the surveillance of antimicrobial resistance.

World over antimicrobial resistance is a major public health problem. The WHONET software program puts each laboratory data into a common code and file format, which can be merged for national or global collaboration of antimicrobial resistance surveillance. In this study, antimicrobial sensitivity of 4,289 bacterial isolates was studied by Kirby-Bauer disk diffusion method. -lactamase production was assessed by iodometric test method. Extended spectrum -lactamase (ESBLs) were screened by ceftazidime disk sensitivity. Drug resistance was high in most of the isolates. It was maximum (80-94%) for ampicillin, nalidixic acid and cotrimoxazole. It varied between 40-60% for gentamicin, clindamycin, fluoroquinolones and coamoxyclav. It ranged from 21 to 38% for amikacin and third generation cephalosporins. Constitutive -lactamase production was highest in S.aureus (28.9%) and ESBL production was maximum in Klebsiella spp. (53.6%). WHONET software has in-built analysis program which helps in forming hospital drug policy, identification of hospital outbreaks and recognition of quality control problems in the laboratory.

Primary cutaneous amoebiasis: case report with review of the literature.

BACKGROUND: Primary cutaneous amoebiasis is a rare clinical entity. The lesions can be successfully treated if suspected and correctly diagnosed. We report an interesting case with review of the literature. METHODS: A 25-year-old man presenting with primary cutaneous amoebiasis with extensive involvement of the anterior abdominal wall is described. Correct diagnosis eluded us for 2 years. Clinical suspicion and a simple bedside test (wet drop preparation examination) were sufficient to diagnose the lesion. Successful treatment was achieved with oral Metronidazole followed by split skin grafting. Only six cases of primary cutaneous amoebiasis could be traced in the literature. CONCLUSIONS: Primary cutaneous amoebiasis is extremely rare. Diagnosis is usually not suspected because of its rarity. Cutaneous amoebiasis responds readily to proper treatment, yet, if unrecognized and neglected, produces significant morbidity and may be fatal.

Shima drinking water--a bacteriological analysis.

300 water samples, 60 from piped supply and 240 from 20 natural sources were analyzed bacteriologically for four important bacterial indicators every month over a period of one year. The MPN of total coliforms, Escherichia coli, Streptococcus faecalis were detected by multiple tube method and Clostridium perfringens was isolated using litmus milk medium. From piped water supply, only one sample was found unfit for human consumption. The plate count at 37 degrees C and 22 degrees C varied from 0.5 x 10(3) to 15 x 10(3) per ml. of water. From natural sources, MPN indices for coliforms, Esch. coli and S. faecalis varied from 3 to > 1800, 0 to > 1800 and 0 to 540 per 100 ml. of water respectively. About 1/3rd of samples showed presence of Cl. perfringens. The plate count varied from 1.0 x 10(3) to > 150 x 10(3) per ml. of water. Salmonella typhi was isolated in 1.25% samples by membrane filtration technique. The water from all the natural sources was unfit for human consumption whereas piped water supply was of good quality in general.

Bacterial indices of drinking water from natural sources.

Two hundred forty samples of water from twenty natural sources were subjected to the study for the detection of four bacterial indicators of faecal pollution. The samples were subjected to the detection of coliform, faecal coliform, E. coli, S. faecalis, Cl. welchii and plate count at 37 degrees C and 22 degrees C. All these samples were found unfit for human consumption. MPN for coliforms, E. coli and S. faecalis varied from 3 to 1800 per 100 ml of water, sero to 1800 per 100 ml water and zero to 540 per 100 ml of water respectively. Plate count at 37 degrees C and 22 degrees C varied from 2.5 x 10(3) to > 150 x 10(3) per ml of water. Cl. welchii was detected in 30.4% samples in rainy season and high plate count at 37 degrees C and 22 degrees C was observed during the same period.

Chromoblastomycosis in India.

BACKGROUND: Four patients with chromoblastomycosis are presented. An additional 30 infected Indian patients are reviewed. RESULTS: These 34 patients ranged in age from 12 to 80 years with a male to female ratio of 5.8 : 1. Onset before the age of 20 years was seen in 24% of cases which was comparatively high. Culture was positive in 72% of cases and sclerotic bodies were observed in 84% of cases. A relatively higher prevalence (15%) of Fonsecaea compacta was observed. Unusual cutaneous sites afflicted were the penile shaft, vulva, and ala of the nose, and unusual extracutaneous spread was seen in the pleural cavity, ileocecal region, laryngotracheal area, and tonsils. Extracutaneous involvement was seen in 24% of cases. Overlapping infection with another fungus, Geotrichum candidum, was seen in one case. CONCLUSIONS: Combination therapy with two azoles was attempted with some success for clinical cure.

Neonatal morbidity in a hospital at Shimla.

During the study period there were 2063 live births. Of these 573 (27.8%) were low birth weight (LBW), 277 (13.4%) preterm and 148 (7.1%) small for date (SFD) babies. In all, 263 (12.7%) newborns suffered from one or the other morbidity. Birth asphyxia of varying severity developed in 130 (6.3%) babies [88 LBW and 42 normal birth weight (NBW) (p < 0.001)]. Respiratory distress syndrome was diagnosed in 82 (3.9%) babies, most being due to hyaline membrane diseases (31.7%), which affected 26 (9.4%) of preterm babies. Deep infections were seen in 109 (5.3%) newborns [60 LBW and 49 NBW, (p < 0.001)] and superficial infections were seen in 79 (3.8%) babies [46 LBW and 33 NBW, (p < 0.001)]. Hyperbilirubinemia was detected in 78 (3.8%) babies. In one fifth of the babies, the cause of hyperbilirubinemia remained unidentified even after detailed investigations. Hypothermia was observed in 59 (2.9%) newborns [48 LBW and 11 NBW, (p < 0.001] and congenital malformations were seen in 24 (1.7%) babies. Morbidity was found to be high amongst LBW and preterm babies. The incidence of deep infections and hypothermia was high in our study.

Non-fermenters in urinary tract infection.

Sixty four (4.4%) strains of non-fermenting gram negative bacteria (NFGNB) were isolated out of 1,380 bacterial isolates from 7,784 urine samples, of which 43 were isolated from male patients and 21 from female patients. P. aeruginosa was found to be the commonest (67.2%) followed by A. lwoffi (7.8%), A. anitratus and P. acidovorans testosterani (6.2% each), P. maltophilia and P. denitrificans (4.8% each), P. putida and P. vesiculare (1.5% each). Forty two(65.6%) of these isolates were isolated as pure cultures and 22(34.4%) as predominant organisms. Most of these isolates i.e. 50-88.8% were sensitive to Norfloxacin and Ofloxacin and 22.2% to 66.6% of these isolates were sensitive to Gentamycin and Cephalexin whereas 11.1% of these isolates were sensitive to Co-trimoxazole and Ampicillin. All of these isolates were resistant to Penicillin and Tetracycline.

Neonatal sepsis in hospital born babies.

Incidence of neonatal sepsis in a study carried out among hospital born babies was found to be 5.3 per cent significantly high (10.9%) amongst low birth weight compared to (3.1%) normal birth weight babies. Sepsis related mortality also exceeded significantly in low birth weight babies. Positive cultures were obtained in 36.7 per cent of babies with sepsis. The organisms identified were Staphylococcus pyogenes (40%), E. coli (27.5%), Klebsiella spp. (15%), Staphylococcus epidermidis (10%) and Enterobacter spp. (7.5%). Gram negative bacilli predominated in early onset (< 72 hrs. of life) and gram positive cocci in late onset. Mortality with early onset culture positive neonatal sepsis was significantly high compared to late onset. The bacterial isolates obtained were found to be resistant to routinely used antibiotics (penicillin, ampicillin and gentamycin). Third generation cephalosporins and aminoglycosides (netilmycin) were found to be effective in treatment of neonatal sepsis.

Sporotrichosis of abdominal wall.

A rare case of sporotrichosis of abdominal wall has been described from high mountainous region of Himachal Pradesh. Its clinical importance has been discussed in the light of available literature.

Nocardia associated with pulmonary tuberculosis.

A total of 209 cases of pulmonary tuberculosis were screened for the presence of Nocardia in their sputa. In 2.9 per cent of the cases Nocardia asteroides was isolated. The increasing importance of this microorganism has been discussed in the light of other reports from India.

The incidence of unerupted permanent teeth and related clinical cases.

The impacted or mal-erupted tooth and its associated pathosis provide great diagnostic challenges to the dentist. The frequency of occurrence of impaction was found to be over 10,000 in 5,000 Army recruits. The type and position of impaction are summarized in tables. The incidence of impactions was higher than previously reported and may reflect some sampling bias. The incidence of impacted second and fourth molars is higher than expected. Impactions or mal-eruptions were seen to involve every permanent tooth except the mandibular incisors and first molars. Impactions can occur because of malpositioning of the tooth bud or obstruction in the path of eruption. However, the exact mechanism is still unknown. Six unusual cases of impacted permanent teeth are described to illustrate the importance of panoramic radiographs in the discovery of some anomalously located impactions.

Gemination and twinning in the permanent dentition.

Gemination and twinning are uncommon developmental anomalies of the hard dental tissue. These aberrations are manifested either as anomalous teeth or as supernumerary teeth. Six cases of gemination and twinning are presented in this article. A simplified classification of these anomalies has been suggested.

Radicular evaginatus--a root anomaly.

An unusual root malformation in a mandibular second premolar is presented. Clinical and histologic findings, as well as treatment ramifications, are discussed. The pathogenesis of this malformation is also discussed. The term radicular evaginatus is suggested for this condition.

A review of the incidence of pain after an operation treatment visit: Part I.

This review presented some typically encountered painful sequellae from routine restorative dental treatment. A brief description of the importance of Tomes' processes and free nerve endings were mentioned also. This review should serve as a background for a clinical study concerning posttreatment pain that will be described in a later article.