Bacterial and fungal biofilm formation on contact lenses and their susceptibility to lens care solutions.

BACKGROUND: Microbial biofilm formation on contact lenses and lens storage cases may be a risk factor for contact lens-associated corneal infections. Various types of contact lens care solutions are used to reduce microbial growths on lenses. OBJECTIVES: The present study aimed at comparing the growths of biofilms on the different contact lenses and lens cases. The study also aimed at determining the effect of lens care solutions and bacteriophage on these biofilms. MATERIALS AND METHODS: One type of hard lens and two types of soft lenses were used for the study. The organisms used were Staphylococcus aureus ATCC 25923, Pseudomonas aeruginosa ATCC 27853, Candida albicans ATCC 60193 and Escherichia coli ATCC 25922. Biofilm production was performed by modified O'Toole and Kolter method and effect of lens cleaning solutions and a crude coliphage on biofilms was also studied. Results were visualised using scanning electron microscopy and quantitated by colony counting method and spectrophotometric measurement of optical density (OD). Statistical analysis was done by SPSS 11.5, Kruskal-Wallis test and Chi-square test. RESULTS: Soft lens cleaning solutions had a significant inhibitory effect (P = 0.020) on biofilm formation on soft lenses and also lens cases (P < 0.001). Soft lens cleaning solution 2 was more efficient than solution 1. However, no such inhibitory effect was observed with regard to hard lens cleaning solution, but for a significant reduction in the OD values (P < 0.001). There was no significant inhibitory effect by bacteriophages. CONCLUSION: This study showed the importance of selecting the appropriate lens cleaning solution to prevent biofilm production on contact lenses.

Factors influencing the television viewing practices of Indian children.

OBJECTIVES: To study the effect of socio-demographic factors, parental regulations and maternal television usage on the television viewing practices of Indian schoolchildren. METHODS: Mothers of 6-12 y old children were interviewed using a pre-tested questionnaire at the pediatric outpatient. The television viewing practices of 405 schoolchildren with maternal television viewing and parental television rules were analyzed. Specific television viewing practices considered harmful in the present study were- viewing television >2 h, viewing television just prior to sleep (at bedtime), predominantly viewing general adult channels and using television as an aid to sleep. RESULTS: 35.8 % (n = 145) of the children viewed television for >2 h on schooldays. 20 % (n = 81) used television as sleep-aid. 28.1 % (n = 114) children had televisions in the room they slept. The frequency of parental television rules were with respect to: duration of viewing- 77.5 % (n = 314), timing of viewing- 63.7 % (n = 258), content- 35.6 % (n = 144). The children of families with the rule needing of parental permission to switch on the television [present in 34.8 % (n = 141) children] had lower harmful television viewing practices: duration of television viewing on schooldays >2 h (23.4 %, n = 33, P < 0.001); television viewed just before sleep (39 %, n = 55, P < 0.001); use of television as sleep-aid (12.1 %, n = 17, P = 0.003). 26.7 % (n = 108) of the mothers viewed television for >2 h. Linear regression analysis showed association between average television duration of children and average maternal television duration on schooldays (Beta = 0.246, t = 5.09, P < 0.001). Binary logistic regression analysis showed that harmful television viewing practices were significantly more in children with television in bedroom [OR = 7.49(4.19-13.38), P < 0.001]. It was reduced significantly by the parental rules on content viewed [OR = 0.41(0.23-0.72), P = 0.002]; need of permission to switch on television [OR = 0.31(0.18-0.53), P < 0.001] and a higher maternal education [OR = 0.29 (0.14-0.59), P = 0.001]. CONCLUSIONS: Lower maternal education, increased maternal television usage, presence of television in bedroom resulted in harmful television viewing practices among Indian children. The parental rules that were effective in countering these were the rule on content viewed and needing parental permission to switch on television.

Proportion of depression and its determinants among type 2 diabetes mellitus patients in various tertiary care hospitals in Mangalore city of South India.

BACKGROUND: Depression is found to be common among patients with diabetes and it is associated with poor outcomes in disease control. This study was carried out to find out the proportion and determinants associated with depression among patients with established type 2 diabetes mellitus (T2DM) in various tertiary care hospitals in Mangalore city of south India. MATERIALS AND METHODS: This study was conducted in one government and three private tertiary care hospitals in Mangalore in December 2010. All consenting patients with confirmed diagnosis of T2DM were interviewed and screened for depression by administering the 9-item PRIME-MD Patient Health Questionnaire (PHQ-9). RESULTS: Of the 230 T2DM patients, 119 (51.7%) were males. The mean age of all participants was 53.61 ± 10.7 years. The median duration of T2DM was found to be 12.1 ± 7.35 years. Among the participants, 71 (30.9%) met the criteria for moderate depression, 33 (14.3%) for severe depression, and the remaining 126 (54.8%) had no clinically significant depression. Only 26 (11.3%) patients were already aware that they were depressed, of whom just 3 had taken medical consultation. Among the risk factors, depression was found to be significantly associated with older age, female gender, low socioeconomic status, unskilled and retired employment status, having complications due to T2DM or comorbidities like hypertension and coronary artery disease, being overweight and being on insulin syringe injections. CONCLUSION: This study found a high proportion of depression among patients with T2DM. Therefore the care of individuals with diabetes mellitus (DM) should include the screening and possible treatment of depression in order to achieve and sustain treatment goals.

The bacterial biofilms in dialysis water systems and the effect of the sub inhibitory concentrations of chlorine on them.

INTRODUCTION: The presence of bacteria in the form of biofilms poses a problem in the fluid pathways of haemodialysis plants and procedures which are aimed to detach and neutralize biofilms are necessary to improve the patient safety and the quality of the healthcare. The present study was therefore aimed at isolating the organisms which colonized dialysis water systems as biofilms, as well as to study the effect of the sub inhibitory concentrations of chlorine on the biofilms which were produced by these isolates. METHODS: Swabs were used to collect the biofilms which were produced on the internal surface of the dialysis tubing from the dialysis units. This study was conducted at the Department of Microbiology, Kasturba Medical College (KMC), Mangalore, India. The cultures were performed on MacConkey's agar and blood agar. The organisms which were isolated were identified and antibiotic sensitivity tests were performed. The biofilm production was done by the microtitre plate method of O'Toole and Kolter. The biofilm production was also studied in the presence of sub inhibitory concentrations of chlorine. RESULTS: Acinetobacter spp and Pseudomonas aeruginosa were the two predominant organisms which colonized the dialysis water systems as biofilms. The sub inhibitory concentrations of chlorine did not bring about any decrease in the biofilm production by the isolates. On the contrary, there was an increase in the biofilm production. CONCLUSION: Our study highlighted the importance of using appropriate methods to improve the quality of the water in dialysis units. This in turn, may help in reducing the biofilm formation in the water systems of dialysis units and thus, contribute to the prevention of hospital acquired infections in the patients who need haemodialysis.

Prevalence of Methicillin Resistant Staphylococcus aureus Carriage amongst Health Care Workers of Critical Care Units in Kasturba Medical College Hospital, Mangalore, India.

BACKGROUND: Outbreaks and prevalence of Methicillin resistant Staphylococcus aureus (MRSA) Nosocomial Infection (NI) among various populations have been well reported in literature, particularly those from developed countries. There is a paucity of information on carriage of MRSA in developing nations, including the carriage by critical healthcare givers who are potential transmitters. AIM AND OBJECTIVES: Present study was aimed at establishing the carriage rate of MRSA among healthcare workers in the critical care units of Kasturba Medical College Hospital, Mangalore, India and at formulating an MRSA control policy, based on the outcomes. MATERIAL AND METHODS: We screened 200 healthcare workers in the critical care units of the Kasturba Medical College Hospital, Mangalore, India, for MRSA and vancomycin susceptibility of the isolates. Swabs taken from both anterior nares were transported, inoculated onto mannitol salt agar (MSA) and incubated aerobically at 37°C for 18-24 hours. Gram positive cocci in clusters, with positive catalase, coagulase and DNAse tests, were identified as S.aureus. Further categorization of S.aureus into MRSA was done by using cefoxitin disc diffusion method. Sensitivity to vancomycin was tested by vancomycin disc diffusion and vancomycin agar screen plating. RESULTS: The number of strains of S. aureus which was isolated from our 200 participants was 35, with a rate of 17.5% of the 35 isolates of S. aureus, 5 (14.3%) were MRSA. None of the S. aureus strains were vancomycin resistant. CONCLUSION: MRSA carriage among healthcare workers who were involved in the management of critically ill patients at Kasturba Medical College hospital, Mangalore, India was 2.5%, which is comfortably low. The existing infection control policy in our hospital seems to be effective and the same should be maintained.

Sex estimation from foramen magnum dimensions in an Indian population.

Identification of skeletal remains is vital in forensic investigations. The need for methods to estimate sex from cranial fragments becomes apparent when only a part of skull is brought for identification. The present research is an attempt to study the sexual dimorphism of the anteroposterior diameter, transverse diameter and area of foramen magnum in a population of costal Karnataka region using statistical considerations. Ninety adult dry skulls of known sex (50 male and 40 female) were included in the study. Morphometric analysis of foramen magnum was conducted using vernier calipers and the area of foramen magnum was calculated. The anteroposterior diameter, transverse diameter and area of foramen magnum are found to be significantly larger in males than females. Binary Logistic Regression (BLR) analysis was performed to derive models for estimation of sex from the different measurements of foramen magnum and Receiver Operating Characteristic (ROC) curve was drawn for the predicted probabilities obtained from BLR analysis. The predictability of foramen magnum measurements in sexing of crania was 65.4% for transverse diameter and 86.5% for the anteroposterior diameter. For the area of foramen magnum that was calculated using the formula derived by Radinsky and Teixeria, the predicted probabilities were observed to be 81.6% and 82.2% respectively. When anteroposterior and transverse diameter were used together in BLR analysis the predictability of sex increased to 88%. However, considering the overlapping in the male and female values for the foramen magnum measurements it is suggested that its application in sex estimation should be restricted to cases where only a fragment of base of the skull is brought for examination. In such cases, the anteroposterior diameter and area of the foramen magnum can be employed as better tools for sexing the skulls than the transverse diameter of the foramen magnum.

Future specialization interests among medical students in southern India.

BACKGROUND: A consideration of the future specialization interests of undergraduate medical students might help to understand the needs of higher medical education and future manpower availability for healthcare. METHODS: A cross-sectional study was conducted among 373 undergraduate students of a medical college in southern India using a self-administered questionnaire. RESULTS: Of the 373 students, 188 (50.4%) were men. Almost all of them (370 [99.2%]) wanted to pursue postgraduation. Of these, 267 (72.4%) wanted to pursue postgraduation in India. Overall, the first choice subject was surgery (120 [32.2%]) followed by internal medicine (85 [22.8%]) and paediatrics (43 [11.5%]). The third preference for men and women differed, with men choosing orthopaedics and women choosing obstetrics and gynaecology. The factors that influenced the choice of specialization were interest in the speciality (Likert scale score 4.7), job satisfaction (4.6), employment opportunities (4.0), job security (4) and high income potential (3.9). CONCLUSION: It was evident from the proportion of students desiring to do postgraduation and their choice of specialties that most of them will end up working at hospitals instead of at primary healthcare centres. The deficiencies of certain specialists such as ophthalmologists are likely to persist. This is a cause for concern as the majority of our population lives in rural areas and there is already a maldistribution of doctors.

Knowledge attitude practice study on pulse polio immunization in Mangalore, Dakshina Kannada district, Karnataka.

Government of India launched PPI in 1995 to eradicate polio by the end of 2000. Despite this 733 cases were reported last year alone. There is a need to understand the reason behind high number of cases being reported even after so many years of programme implementation. This study was therefore conducted to assess knowledge of people about polio and PPI, their attitude and practice towards PPI. This cross sectional study was done in Mangalore city of Karnataka. Only houses having under five children were taken for the study. Data was collected by interviewing any adult member of the household using a pretested questionnaire. Out of 100 participants 99 were literates but only 11 knew the correct mode of transmission of polio. Twenty seven had misconception that polio is a curable disease. Only 40 participants knew that polio drops can be given to children even with mild illnesses. Few (2%) participants felt that PPI causes vaccine overdose and 8 participants thought PPI to be a substitute for routine immunization. This study identified few important misconceptions associated with polio and PPI. This needs to be addressed by large scale awareness campaigns in order to eradicate polio in the near future.

Anti-biofilm and anti-adherence activity of Glm-U inhibitors.

BACKGROUND: Intravascular catheters and urinary catheters are an important source of hospital-acquired infections. Many microorganisms colonize indwelling catheters, including central venous catheters (CVCs) forming biofilms and cause infections that are difficult to treat. Although various methods have been employed to reduce biofilms, enzymes involved in bacterial cell wall synthesis could provide novel targets for the development of anti-biofilm agents. N-Acetylglucosamine-1-phosphate uridyltransferase (GlmU) is an essential enzyme in aminosugars metabolism and catalyzes the formation of uridine-diphospho-N-acetylglucosamine (UDP-GlcNAc), an important precursor in the peptidoglycan and lipopolysaccharide biosynthesis of Gram-positive and Gram-negative bacteria. Previous study has been conducted on the anti-biofilm effect of GlmU inhibitors such as N-ethyl maleimide (NEM) and NEM analogs along with a cationic polypeptide protamine sulfate (PS), which enhanced its anti-biofilm activity. AIM: The present study aimed at finding the effect of sub-inhibitory concentrations of N-ethyl maleimide (NEM) and protamine sulfate (PS) on the biofilms produced by Pseudomonas aeruginosa and Enterococcus spp. isolated from cases of catheter-associated UTI as well as Klebsiella pneumoniae and Staphylococcus aureus isolated from cases of catheter-related bloodstream infections (CRBSI). MATERIALS AND METHODS: In order to enhance the activity of NEM and to develop a broad-spectrum anti-microbial composition, NEM (50 µg/ml) was combined with protamine sulfate (50 µg/ml) and tested for anti-biofilm activity using a standard quantitative biofilm assay method. RESULTS AND CONCLUSION: It was observed that NEM had no effect on the biofilm produced by Pseudomonas aeruginosa as well as by Enterococcus spp. NEM also caused a significant decrease in biofilm production by Staphylococcus aureus while it had no effect on the biofilm produced by Klebsiella pneumoniae. There was a significant synergistic inhibitory effect on Staphylococcus aureus and Enterococcus spp., whereas Pseudomonas aeruginosa and Klebsiella pneumoniae remained unaffected. Combination of GlmU inhibitor-plus-protamine sulfate failed to significantly reduce bacterial adherence of Pseudomonas aeruginosa and Klebsiella pneumoniae to catheter and cannula pieces, respectively. We found that the GlmU inhibitor was mainly effective in preventing the adherence and biofilm formation by gram-positive organisms. The combination of NEM and protamine sulfate may, therefore, be tried as anti-infective coatings for medical devices such as catheters and cannulas, and thus help in overcoming microbial resistance in the current era of increasing device-associated hospital infections.

Association of depression with social support and self-esteem among HIV positives.

BACKGROUND: Depression in Human Immunodeficiency Virus (HIV) positives has implications such as poor drug compliance, lower quality of life, faster progression to full blown Acquired Immunodeficiency Syndrome (AIDS) and higher mortality. AIMS: To assess depression, social support and self-esteem in HIV positives and to find out the association of depression with social support and self-esteem among HIV positive patients. SETTING AND DESIGN: Kasturba Medical College (KMC) Hospital, a tertiary care hospital, Mangalore, India and cross-sectional design. METHODS AND MATERIALS: Study constituted of 105 HIV positive subjects; depression was assessed using BDI (Beck depression inventory), social support was assessed using Lubben social network scale and self-esteem was assessed using Rosenberg self-esteem scale. STATISTICAL ANALYSIS: Kappa statistics was used to measure the agreement of depression assessed by BDI with clinical diagnosis of depression. Logistic regression analyses were done to find out predictors of depression among HIV positives. All analyses were conducted using Statistical Package for Social Sciences (SPSS) version 11.5. RESULTS: Depression was found to be present in 43.8% of HIV positives. Among the study subjects, 10.5% had high risk for isolation and low self-esteem was found only among 5.7%. In univariate analysis both gender and self-esteem were significantly associated with depression whereas in multivariate analysis only self-esteem was found to be significantly associated with depression. CONCLUSION: The present study shows a high prevalence of depression in HIV positive patients along with the importance of self-esteem.

A comparison of responses to alcohol expectancy questionnaire (CEOA) of Indian and Malaysian medical students.

Alcohol addiction is a social problem faced by every country worldwide. Young people are more at risk of this menace. In spite of a clear knowledge and message about the effects of alcohol on individual health and social fabric, it is hard to curb the overuse of this beverage. In the present study, we compared the outcome of a survey using Comprehensive effects of Alcohol (CEOA) in two private Medical institutions in two Asian countries, viz. KMC, Mangalore, India (n=180) and AIMST, Kedah, Malaysia (n=170). The study included both males and female students. The result suggested that the negative reinforcement responses were rated higher in both the study groups. But those who have tasted alcohol before had a higher rating that alcohol may cause positive reinforcement. Both groups of respondents showed similar trend suggesting that the alcohol expectancies are similar in Indian students and Malaysian students. From the results we could conclude that the responses of the two sample groups were comparable to each other. While the male respondents were inclined show higher affinity towards acceptance of alcohol females are very much less so. However, the respondents of both groups appeared to be well aware of the negative aspects of alcohol. Importantly previous exposure to alcohol intake dramatically changed the perception and showed increased inclination towards alcoholism. This study thus provides an important clue to the clinician, counselors and parents regarding the importance of guiding the young people about the alcoholism.

Determinants of low birth weight: a case control study in a district hospital in Karnataka.

A Case-control study was conducted in District Lady Goschen hospital, Dakshina Kannada district, Southern Karnataka. Subjects were mothers who underwent normal delivery and their neonates. A total of 150 cases and 300 controls were selected. Significant risk factors identified in univariate analysis included pre pregnancy maternal weight (<45 kgs)(OR=6.77), anaemia in pregnancy (Hb<11 gm%) (OR=3.11), age less than 20 years (OR=2.96) and maternal height (<145 cms) (OR=2.79). Multiple logistic regression analysis revealed that pre pregnancy maternal weight (<45 kgs)(OR=7.02), anemia in pregnancy (OR=4.37) and maternal age less than 20 years (OR=3.96) were the significant risk factors of low birth weight of term babies. The strategy needs to focus attention on nutrition education to facilitate better weight gain during adolescent period. Discouraging teenage pregnancy is also essential in order to reduce the burden of LBW babies.

Stature estimation from foot length using universal regression formula in a North Indian population.

Stature is a significant parameter in establishing identity of an unknown. Conventionally, researchers derive regression formula separately for males and females. Sex, however, may not always be determined accurately, particularly in dismembered remains and thus the need for a universal regression formula for stature estimation irrespective of sex of an individual. The study was carried out in an endogamous group of North India to compare the accuracy of sex-specific regression models for stature estimation from foot length with the models derived when the sex was presumed as unknown. The study reveals that regression equation derived for the latter can estimate stature with reasonable accuracy. Thus, stature can be estimated accurately from foot length by regression analysis even when sex remains unknown.

Prevalence of goitre among school children in Belgaum district.

OBJECTIVE: A school survey was conducted to estimate the prevalence of goitre among schoolchildren in Belgaum district. METHODS: A cross-sectional study was conducted in primary, middle and high schools of villages selected. All the children of the selected schools were examined for the presence of goitre and the salt samples obtained from their homes were tested for iodine content. RESULTS: Overall prevalence of goitre was 16.7%. Prevalence of palpable goitre was 16.4 % and visible goitre was very low (0.3%). Higher prevalence was found among females (21.1%) when compared to that of male children (12.8 %). Prevalence of goitre increased significantly with advancement of age until 16-yr. 72.1 % children were consuming rock salt and only 27.9 % were consuming powdered salt at their homes. Estimation of Iodine content in the salt samples showed that 68.7 % of the sample had inadequate iodine content. Prevalence of goitre was significantly high among children who consumed rock salt (16.2%) as compared to those who used powdered salt (11%) CONCLUSION: Strict implementation of salt codization and marketing in rural area is desired. Also health education programme be showed.

Stature estimation from foot dimensions.

Identification of an individual is the mainstay in forensic investigations. The dimensions of the foot have been used for the determination of sex, age, and stature of an individual. The present study examines the relationship between stature and foot dimensions among Gujjars, a North Indian endogamous group. Stature, foot length and foot breadth of 200 subjects comprising 100 males and 100 females were measured. Statistical analyses indicated that the bilateral variation was insignificant for all the measurements except foot breadth in males (p<0.01). Sex differences were found to be highly significant for all the measurements (p<0.01). Linear and multiple regression equations for stature estimation were calculated using the aforementioned variables and multiplication factors were computed. The correlation coefficients between stature and foot dimensions were found to be positive and statistically highly significant. The highest correlation coefficient between stature and foot length in males and foot breadth in females indicates that the foot length provides the highest reliability and accuracy in estimating stature of an unknown male and foot breadth in a female. Prediction of stature was found to be most accurate by multiple regression analysis.