Point prevalence & risk factor assessment for hospital-acquired infections in a tertiary care hospital in Pune, India.

BACKGROUND & OBJECTIVES: Hospital-acquired infections (HAIs) are a major challenge to patient safety and have serious public health implications by changing the quality of life of patients and sometimes causing disability or even death. The true burden of HAI remains unknown, particularly in developing countries. The objective of this study was to estimate point prevalence of HAI and study the associated risk factors in a tertiary care hospital in Pune, India. METHODS: A series of four cross-sectional point prevalence surveys were carried out between March and August 2014. Data of each patient admitted were collected using a structured data entry form. Centers for Disease Control and Prevention guidelines were used to identify and diagnose patients with HAI. RESULTS: Overall prevalence of HAI was 3.76 per cent. Surgical Intensive Care Unit (ICU) (25%), medical ICU (20%), burns ward (20%) and paediatric ward (12.17%) were identified to have significant association with HAI. Prolonged hospital stay [odds ratio (OR=2.81), mechanical ventilation (OR=18.57), use of urinary catheter (OR=7.89) and exposure to central air-conditioning (OR=8.59) had higher odds of acquiring HAI (P<0.05). INTERPRETATION & CONCLUSIONS: HAI prevalence showed a progressive reduction over successive rounds of survey. Conscious effort needs to be taken by all concerned to reduce the duration of hospital stay. Use of medical devices should be minimized and used judiciously. Healthcare infection control should be a priority of every healthcare provider. Such surveys should be done in different healthcare settings to plan a response to reducing HAI.

Antimicrobial use and antimicrobial resistance in nosocomial pathogens at a tertiary care hospital in Pune.

BACKGROUND: Resistance to antimicrobial agents is emerging in wide variety of nosocomial and community acquired pathogens. Widespread and often inappropriate use of broad spectrum antimicrobial agents is recognized as a significant contributing factor to the development and spread of bacterial resistance. This study was conducted to gain insight into the prevalent antimicrobial prescribing practices, and antimicrobial resistance pattern in nosocomial pathogens at a tertiary care hospital in Pune, India. METHODS: Series of one day cross sectional point prevalence surveys were carried out on four days between March and August 2014. All eligible in patients were included in the study. A structured data entry form was used to collect the data for each patient. Relevant samples were collected for microbiological examination from all the clinically identified hospital acquired infection cases. RESULTS: 41.73% of the eligible patients (95% CI: 39.52-43.97) had been prescribed at least one antimicrobial during their stay in the hospital. Beta-lactams (38%) were the most prescribed antimicrobials, followed by Protein synthesis inhibitors (24%). Majority of the organisms isolated from Hospital acquired infection (HAI cases) were found to be resistant to the commonly used antimicrobials viz: Cefotaxime, Ceftriaxone, Amikacin, Gentamicin and Monobactams. CONCLUSION: There is need to have regular antimicrobial susceptibility surveillance and dissemination of this information to the clinicians. In addition, emphasis on the rational use of antimicrobials, antimicrobial rotation and strict adherence to the standard treatment guidelines is very essential.

3-D Spiral Computerised Tomographic Angiography in Evaluation of Potential Renal Donors.

A total of 30 potential renal donors aged between 35 and 50 years were subjected to pre-operative 3-Dimensional Spiral Computerised Tomography (CT) angiography with the aim to assess its efficacy in the evaluation of renal vasculature. The investigations were carried out on a Philips Tomoscan AV Spiral CT scanner. Scan parameters included a collimation of 3 mm and table speed of 4 mm/sec. A total of 120 ml of non-ionic contrast was injected at a rate of 4 ml per second using a power injector. The axial images obtained were reconstructed at 2mm intervals and 3-D reconstruction was done using Surface Shaded Display (SSD) and Maximum Intensity Projection (MIP) protocols. CT angiography and its correlation with per-operative findings revealed 97 to 100% sensitivity and specificity in identifying the main and accessory renal arteries and veins. The angiogram also excluded the presence of pathologies like polycystic kidney, horse shoe kidney with a thick isthmus and occult renal cell carcinoma that would prevent the patient from being a donor. 3-D spiral CT angiography allows the radiologist to provide the transplant surgeon with precise pre-operative anatomy of the renal vasculature thus reducing the risks and complications associated with the harvesting procedure and increasing the chances of a successful outcome. Thus it is a fast, accurate, inexpensive and minimally invasive procedure that is becoming the modality of choice for the pre-operative evaluation of potential renal transplant donors.

A case of carcinoma rete testis: histomorphological, immunohistochemical and ultrastructural findings and review of literature.

A 72-year-old man presenting with a secondary hydrocoel underwent orchidectomy. Gross examination revealed a tumor arising in the region of the rete testis, which on histopathology proved to be a papillary adenocarcinoma. The patient did not have evidence of any other neoplasia elsewhere in the body. The lesion fulfilled the anatomic criteria elucidated by Nochomovitz et al to be labelled as adenocarcinoma of Rete testis. Electron microscopy revealed characteristic nuclear infoldings and microtubules with two different arrangements. The tubules were either seen to form concentric circles or were in irregular groups with filaments interspersed. The lesion on immunohistochemistry was negative for germ cell markers AFP and HCG, and was positive for cytokeratin and epithelial membrane antigen. A review of literature is also presented.

Autoinhibition and desensitization of serotonergic responses in guinea pig ileum.

The present study was undertaken to investigate the autoinhibition and desensitization of 5-hydroxytryptamine (5-HT) using another agonist MK-212 on guinea pig ileum. 5-HT and MK-212 produced dose dependent contractions of guinea pig ileum. The responses to MK-212 were reduced in the presence of 5-HT and vice versa. Neither 5-HT nor MK-212 produced any change in the responses to histamine, acetylcholine or KCl. Increase in Ca++ in bathing fluid reversed the desensitization produced by MK-212 or 5-HT. Our data suggest that 5-HT and MK-212 produce desensitization which is specific for serotonergic receptors and possibly involves Ca++ ions.

Interactions of levamisole with some autonomic drugs on guinea-pig vas deferens.

The effects of levamisole on responses to various agonists were studied in guinea-pig vas deferens. Levamisole did not itself exhibit any contractile or relaxant effect on guinea-pig vas deferens but in the presence of levamisole the concentration-response curve of noradrenaline (NA) was shifted to the left and the maximal response was increased. Responses to field-stimulation at 5 and 10 Hz were potentiated by levamisole. Cocaine and denervation caused potentiation of NA responses and these enhanced responses remained unchanged in the presence of levamisole. Acetylcholine (ACh) responses were potentiated by levamisole whereas responses to histamine, KCl and methoxamine remained unaltered. These results suggest that levamisole does not have any action at postsynaptic alpha-adrenoreceptors. The increased responses to NA and ACh in the presence of levamisole may be due to its uptake1, blocking and anticholinesterase activities respectively.

Identification and specific blockade of histaminergic receptors in guinea pig vasa deferentia.

Histamine produces contractions of the guinea pig vas deferens. The present investigation was undertaken to characterize the nature of histaminergic receptors in this tissue. Histamine (1.6 X 10(-6) M to 3.2 X 10(-5) M) produced dose-related contractions of guinea pig vas deferens (GPVD). Mepyramine (5.3 X 10(-8) M and 1 X 10(-9) M) blocked the responses to histamine competitively. Metiamide (1.23 X 10(-5) M) did not block the responses to histamine significantly. Specific H1 and H2 receptor agonists, namely 2-(2'-pyridyl)ethylamine (PEA) (2.55 X 10(-6) M to 3.0 X 10(-5) M) and 4-methylhistamine (4-MH) (2.52 X 10(-5) M to 3.0 X 10(-4) M), respectively, produced dose-related contractions of GPVD. The responses to PEA were blocked competitively by mepyramine, whereas the responses to 4-MH were blocked by metiamide. Reserpine pretreatment (5 mg/kg, i.p., 24 h) did not alter the responses to histamine and PEA. Our data suggest the presence of both H1 and H2 receptors in the GPVD which are excitatory in nature.

Analytical behaviour of poly(vinyl acetate) and its hydrolysis products with iodine.

Formation of the red complex between poly(vinyl acetate) and iodine in the presence of iodide is quantitatively independent of the method by which the polymer is prepared. In contrast, the amount of complex formed in the case of partly hydrolysed products of poly(vinyl acetate) depends strongly on the source of this polymer and may vary from sample to sample by as much as a factor of five, while the use of different hydrolysis methods gives rise to even greater differences in the amount of complex formed by the products. The determination of partly hydrolysed poly(vinyl acetate) through the red iodine complex is recommended only when the standard polymer sample and the unknown have been prepared in the same batch. Details of these systems are discussed.