Interpretation of Antimicrobial Susceptibility Testing Using European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Clinical and Laboratory Standards Institute (CLSI) Breakpoints: Analysis of Agreement.

OBJECTIVES: Breakpoints provided by European Committee on Antimicrobial Susceptibility Testing (EUCAST) are now being used in many countries. This study was planned to ascertain the agreement in antimicrobial susceptibility using the Clinical and Laboratory Standards Institute (CLSI) and EUCAST breakpoints during the Kirby-Bauer disk diffusion method. METHODS:  This was a prospective observational study. Clinical isolates belonging to the family Enterobacteriaceae recovered between January and December, 2022, were included in the analysis. The diameter of the zone of inhibition of the 14 antimicrobials (viz. amoxicillin/clavulanic acid, cefazolin, ceftriaxone, cefuroxime, cefixime, aztreonam, meropenem, gentamicin, amikacin, ciprofloxacin, levofloxacin, norfloxacin, trimethoprim/sulfamethoxazole and fosfomycin) was analysed. Antimicrobial susceptibility was interpreted using CLSI 2022 and EUCAST 2022 guidelines.  Results: Susceptibility data from a total of 356 isolates showed a slight increase in the percentage of resistant isolates with most of the drugs using EUCAST guidelines. The level of agreement varied from almost perfect to slight. For two drugs, i.e., fosfomycin and cefazolin, the agreement was least among the drug analysed (kappa (κ) value < 0.5, p < 0.001). For Ceftriaxone and Aztreonam, with EUCAST, susceptible (S) isolates would have been categorised in the newly redefined "I" category. It would have indicated the use of higher dosages of drugs.  Conclusion: Change in the breakpoints impacts the interpretation of the susceptibility. It can also lead to a change in the dosage of the drug used for treatment. Therefore, there is an urgent need to see the impact of recent modifications "I" category of EUCAST on the clinical outcome and usage of antimicrobials.

Effectiveness of yoga on Ewing's battery autonomic function test: cross-sectional study.

INTRODUCTION: The cardiovascular autonomic functions can be tested by a Battery of five tests developed by Ewing and Clark in 1981 in Edinburgh. Yogic practices are immensely useful for physical, mental and spiritual development required for better autonomic function. AIM AND OBJECTIVES: To assess the ANS (Autonomic function system) function with help of Ewing's Battery tests in yoga participants and healthy participants not practicing yoga. MATERIALS AND METHODS: A cross-sectional study was conducted on 270 participants which were divided into two groups viz: 135 in healthy control (Group I) and 135 in yoga group (Group II). Subjects with informed consent between 40-50 years, were included in control (Group I) and those practicing yoga for past minimum 3 months were included in Group II. Anthropometric measurements were done and parasympathetic tests like Heart rate (HR) response to standing from the supine posture, to Valsalva maneuvers and to slow deep breathing were done. Also, sympathetic tests, Blood Pressure (BP) response to cold in cold pressor test (CPT), to sustained handgrip test and to standing from lying posture were carried out. RESULTS: P value was found to be statically significant among yoga group as compared with healthy control group in all the sympathetic and parasympathetic tests except in CPT. As per the Ewing's criteria, normal, early, diseased and severe CAN (Cardiac autonomic neuropathy) in healthy controls findings were 11.11%, 58.51%, 37.03%, 17.77% and in yoga participants findings were 37.7%, 34.8%, 6.66% and 8.88% respectively. According to Bellavere's classification, maximum diseased CAN were found in healthy control as compared to yoga group. As per AIIMS (All India Institute of Medical Sciences) criteria, parasympathetic neuropathy was observed in 11.85% of the healthy controls and in 6.66% of the yoga group, and that maximum sympathetic neuropathy was observed in 11.11% of the healthy patients and only 3.7% of the yoga group. CONCLUSION: More emphasis should be given on implementation of yoga from early ages at the institutional levels, hospital levels. Yoga practices will suffice and lead to improvement of unhealthy ANS condition. Overall, Yoga showed better ANS function than healthy control group.

A study of the association between virulence factors and antifungal susceptibility profile of Candida species recovered from cases of vulvovaginal candidiasis.

Background: The incidence of mycotic infections, especially of Candida, has gradually increased over the past few years. In clinical practice, azoles are the most frequently used antifungal agents and the growing incidence of systemic candidiasis and resistance to antifungals have become a matter of concern worldwide. Virulence factors in Candida spp. may be critical for predicting the response of antifungal drugs. Objectives: This study aimed to identify the relationship between virulence factors and the antifungal susceptibility of Candida. Methodology: This cross-sectional study was conducted on a sample of 55 Candida strains isolated from vulvovaginal samples of patients in the reproductive age group, presenting with signs and symptoms of vulvovaginitis in a large tertiary care hospital in central India. Results: A majority of the Candida were sensitive to three tested drugs (89% to amphotericin B, 76.4% to fluconazole, and 89.1% to voriconazole). Resistance to fluconazole was highest at 16.4%. No significant relationships were identified between antifungal sensitivity of the three azoles with biofilm formation, phospholipase, or proteinase synthesis. Conclusions: High level of antifungal resistance to the three antifungals, especially to voriconazole, is worrisome; however, none of the virulence markers have a significant association with antifungal sensitivity of Candida species. This finding rules out the effect of the virulence of the pathogen on drug response.

A Review on Autonomic Functional Assessment in Diabetic Patients.

In today's world, science has progressed significantly, yet most people are still unaware of diabetes. Lack of obesity, physical work, and lifestyle changes are the main factors. Diabetes is becoming more common all around the globe. Type 2 diabetes may go unnoticed for years, resulting in serious consequences and high healthcare expenses. The goal of this study is to look at a wide range of studies in which the autonomic function of diabetic people has been studied with the help of various autonomic function tests (AFTs). AFT is a non-invasive approach to assessing patients for testing sympathetic and parasympathetic responses to stimuli. AFT findings give us comprehensive knowledge of the autonomic physiology reactions in normal and in autonomic diseases like diabetes. This review will concentrate on AFTs that are scientifically valid, trustworthy, and clinically beneficial, according to experts.

A review on cultural competency in medical education.

Cultural competency is a wide notion with a variety of academic bases and differing perspectives on how it should be implemented. While it is widely acknowledged that cultural competency should be an element of general practise, there is a paucity of literature in this area. It has been commonly claimed that cultural competency is a fundamental prerequisite for working well with persons from different cultural backgrounds. Medical students must learn how to connect successfully with patients from all walks of life, regardless of culture, gender, or financial background. Hence, National Medical Council (NMC) has included cultural competence as a course subject in the curriculum of medical education. The opportunities and concept of Competency Based Medical Education, the inclusion of cultural competency in medical course by NMC, various models and practice skill of cultural competence in medical education are discussed in this paper. This study will be useful to researchers who are looking at cultural competency as a research variable that influences study result.

Clinical applications of EEG as an excellent tool for event related potentials in psychiatric and neurotic disorders.

Electroencephalography is an excellent tool for assessing neurobiological and neurotransmission dysfunction. Event-related potentials (ERPs) are a simple, non-invasive method of studying neurophysiology. ERPs reflect complex activity of neural networks to blame for discriminative behavior of people and recognition of novel stimuli. They are defined as brain voltage fluctuations linked in time with some physical or mental event. EEG is used to assess ERPs, and its use has grown in popularity since the 1960s. This article provides an overview of the ERP methods as well as the properties of the various ERP components (contingent negative variation, namely wave P300, Bereitschafts potential, and mismatch negativity). It also describes ERP alterations linked with neurologic and psychiatric disorders and discusses the possibility of using this technique in experimental psychology. ERPs may reveal psychophysiological characteristics in obsessive compulsive disorder patients, which may have therapeutic and pharmacological consequences. The P3 wave is the most significant and researched component of the ERP record. It is divided into two parts: P3a and P3b. The P3 wave has therapeutic significance, in addition to its application in neurophysiological and psychophysiological research. One neurophysiology indicator of cognitive impairment in depression is the P300 component of the ERPs. The severity of the illness as well as sociodemographic disparities is likely to influence individuals with neurotic disorders' access to psychiatric care in the general community.

Effect of body mass index on cardiorespiratory parameters among medical students: a cross-sectional study.

BACKGROUND: Obesity is a global crisis due to its significant contribution to mortality and morbidity. This study discovered an association between body mass index (BMI) with pulmonary function tests (PFTs) and aerobic capacity (VO2 max) in medical students of Zydus Medical College and Hospital, Dahod, Gujarat. AIM: The study aimed to determine the effect of obesity on cardiopulmonary health of medical students. OBJECTIVES: The study objectives were as follows: 1. To compare PFT parameters and VO2 max between obese and non-obese students. 2. To study the correlation of BMI with PFTs and VO2 max. MATERIAL AND METHODS: BMI was calculated with the formula BMI = weight/height2. PFTs were assessed with computerized spirometry. Aerobic capacity was calculated with Astrand 6-minute Cycle Test. Statistical analysis was done with unpaired t-test. RESULTS: This study found a significant difference in forced vital capacity (FVC), forced expiratory volume in 1 minute (FEV1), slow vital capacity (SVC), maximum ventilatory volume (MVV), and VO2 max between obese and non-obese students (P<0.05). There was a positive correlation between BMI and forced mid-expiratory flow (FEF25-75), peak expiratory flow rate (PEFR), MVV, SVC, expiratory reserve volume (ERV), and MVV and negative correlation with FVC, FEV1, lung age, and VO2 max in non-obese students. There was also a positive correlation between BMI and PEFR, SVC, FVC, FEV1, lung age, MVV, ERV, and a negative correlation with FEF25-75 and VO2 max in obese students. CONCLUSION: As BMI is inversely related to cardiopulmonary function, students having high BMI can be motivated toward a healthy lifestyle.