Infection Control Practices among Undergraduate Dental Students: Case of a Private Dental Institution in North India

Objective: Transmission of infectious agents in a dental clinic is unavoidable. A considerable emphasis must be placed on observing a strict protocol for infection control. The present study assesses infection control practices undertaken by undergraduate dental students in a dental college in North India.Materials and Methods: Along with the general information (age, gender and year of study), a self-applied questionnaire (15 questions with dichotomous response of yes/no) was administered to third- and fourth-year undergraduate students. Fisher exact test was used to assess the differences according to the student year of study and gender.Result: Receiving an overall response rate of 94.2%, highest responses in “yes” were received for wearing and changing gloves and wearing face masks. Changing face masks, hand pieces and burs between patients was practiced more by the senior students, whereas using a special container for disposing of sharp objects was reported more by juniors (p<0.05). No difference among genders was seen.Conclusion: The present study reports unsatisfactory infection control practices, which calls for strict follow-up of infection control guidelines

Coexisting choroidal neovascularization and active retinochoroiditis—an uncommon presentation of ocular toxoplasmosis

Abstract Background Choroidal neovascularization during the active stage of Toxoplasma retinochoroiditis is an uncommon clinical presentation. The authors retrospectively reviewed medical charts of patients with coexisting choroidal neovascular membrane and active Toxoplasma retinochoroiditis. Findings Three patients presented with coexisting choroidal neovascular membrane and active Toxoplasma retinochoroiditis. All lesions had adjacent subretinal hemorrhage. The diagnosis was confirmed based on clinical presentation, fundus fluorescein angiography (FFA), and optical coherence tomography (OCT) findings. The patients were managed with a combination of treatments including intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), oral anti-Toxoplasma treatment, and oral corticosteroids. In all patients, the retinitis lesion resolved in 6 weeks and the coexisting choroidal neovascular membrane resolved over 6 to 12 weeks. Conclusions Recurrences in Toxoplasma retinochoroiditis are common as satellite lesions adjacent to an old atrophic scar. Coexisting choroidal neovascularization with active Toxoplasma retinochoroiditis is an important presentation and should be suspected in the presence subretinal hemorrhage and managed with a combination of anti-Toxoplasma treatment and intravitreal anti-VEGF. </jats:sec

Technology for Improving Street Dog Welfare and Capturing Data in Digital Format during Street Dog Sterilisation Programmes

Street dogs survive on food handouts provided by individuals, or the wider community yet typically receive limited to no veterinary care. They can also carry a variety of zoonotic diseases such as rabies, posing a significant risk to human and dog population health. Dog sterilization is one of the most humane and effective methods available to control street dog populations. Dog sterilization programs, particularly those operating at a large-scale, often face a variety of challenges including limited resources, staffing, and less-than-ideal facilities. Record keeping is often a challenge as well, which can complicate the return of a sterilized dog to their location of capture. Street dogs are territorial, and the return of a dog to an incorrect location is fraught with various welfare issues, as well as an increased risk of postoperative complications, including death. Humane Society International developed a mobile phone-based application called ‘HSIApps’ drawing on years of field experience and data collection in street dog location recording, as well as clinical and postoperative treatment. HSIApps facilitates the return of dogs back to their exact captured location, which ensures dog welfare, and generates reports of a variety of useful data variables to maximize the efficacy and reliability of sterilization programs

Role of Freedom to Operate in Business with Proprietary Products

204-209A comprehensive Freedom to Operate (FTO) analysis requires analysing all forms of valid intellectual property (IP) rights and associated agreements and contracts to ensure that development or launch of any particular product/process in a particular market, in a particular country does not infringe any IP right of third party. FTO opinion is usually a legal advice; however, R&D organizations engaged in frequent patenting may also need to develop their in-house capability for FTO analysis. This paper illustrates methodology for FTO analysis, limited to patent rights

Bilateral endogenous endophthalmitis caused by vancomycin-resistant Staphylococcus epidermidis in a neonate

BACKGROUND: Neonatal bilateral endogenous endophthalmitis is rare and often results in devastating visual outcome. FINDINGS: An 18-day-old neonate presented with whitening of the cornea in the left eye. The child was examined under anesthesia, and a diagnosis of bilateral endogenous endophthalmitis was made. Vitreous biopsy from the left eye showed no growth. Blood samples showed growth of Staphylococcus epidermidis which was multidrug resistant (including vancomycin) but sensitive to piperacillin-tazobactam. The patient was managed with bilateral intravitreal injections of piperacillin-tazobactam and systemic cefpodoxime. Systemic and topical antibiotics were given for 3 and 8 weeks, respectively, and infection was controlled. At 2-year follow-up, the right eye is fixing and following to light with clear view of the fundus and the left eye has a clear cornea with red glow of the fundus. CONCLUSIONS: Vancomycin-resistant S. epidermidis may be a cause of endogenous endophthalmitis. Intravitreal piperacillin-tazobactam and systemic cefpodoxime were used to eliminate the infection in this neonate

Endophthalmitis Caused by Methicillin-Resistant Staphylococcus aureus (MRSA)

Staphylococcus aureus is an important human bacterial pathogen responsible for a wide variety of ocular diseases, including sight-threatening infections such as keratitis, corneal flap melt after laser-assisted in situ keratomileusis (LASIK), cellulitis, endophthalmitis, and panophthalmitis. Staphylococcus aureus isolates that are resistant to methicillin are known as methicillin-resistant Staphylococcus aureus (MRSA) and are usually also resistant to other β-lactam antimicrobial drugs. In current practice, methicillin sensitivity is usually performed with oxacillin or cefoxitin, as methicillin is no longer commercially available in the United States. Oxacillin is more likely to maintain its activity during storage better than methicillin, while cefoxitin can give more reproducible and accurate results than tests with oxacillin or methicillin. The organisms are still called “MRSA” and not “oxacillin-resistant Staphylococcus aureus” or “cefoxitin-resistant Staphylococcus aureus” because of this historic role

Clinical experience in treatment of diffuse unilateral subretinal neuroretinitis

PURPOSE: To describe the clinical features, management, and outcomes of patients with diffuse unilateral subacute neuroretinitis (DUSN). METHODS: A noncomparative, consecutive analysis of case series from two tertiary care campuses of LV Prasad Eye Institute, India, between January 2011 and April 2014 was performed. Medical records of the patients presenting with DUSN (early or late stage) were reviewed. RESULTS: The current study included 13 patients. The majority (10/13, 76.92%) of the patients were aged 20 years or less. All patients had unilateral eye involvement. Visual acuity at presentation was 20/200 or worse in 9/13 (69.23%) patients. A delay in diagnosis occurred in 6/13 patients, and initial diagnosis in these patients included retinitis pigmentosa (4 patients) and posterior uveitis (2 patients). Clinical features included early presentation (prominent vitritis, localized retinitis, and vasculitis) in 7/13 (53.85%) patients and late presentation (attenuation of vessels, retinal pigment epithelium atrophic changes, and optic atrophy) in 6/13 (46.15%) patients. Worm could not be identified in any of the cases. All the patients received laser photocoagulation of retina and oral albendazole treatment for a period of 30 days. With treatment, visual acuity improved in seven patients (six early stage, one late stage) and remained unchanged in six patients. Mean follow-up period was 8.69 months (range, 1–21 months). The mean central foveal thickness in the affected eye, done by optical coherence tomography, during the late stage of the disease was 188.20±40 µm (range, 111–242 µm), which was significantly thinner than the fellow eye, 238.70±36.90 µm (range, 186–319 µm), P=0.008. CONCLUSION: DUSN is a serious vision threatening disease, which may progress to profound vision loss in the later stage of the disease. Visualization of subretinal worm is usually not possible. Treatment with high-dose albendazole therapy and laser photocoagulation may alter the blood–retinal barrier and may be useful in achieving visual recovery

Endophthalmitis caused by gram-positive bacteria resistant to vancomycin: Clinical settings, causative organisms, antimicrobial susceptibilities, and treatment outcomes

Purpose: To report the clinical settings, causative organisms, antimicrobial susceptibilities, and treatment outcomes of patients with endophthalmitis caused by gram-positive bacteria resistant to vancomycin. Methods: Retrospective case series of all patients with culture-proven endophthalmitis caused by gram-positive bacteria resistant to vancomycin between January 2010 and December 2016 in LV Prasad Eye Institute, Visakhapatnam, India. Results: The current study included 14 patients. The clinical settings were post-cataract surgery in 8/14 (57.1%) and open globe injury in 6/14 (42.8%). Primary intervention for all patients included tap and intravitreal antibiotic injection. During subsequent follow-up, pars plana vitrectomy was performed in 6 patients and one patient underwent penetrating keratoplasty. Mean number of intravitreal antibiotic injections performed were 3.4 per patient. The most common organisms isolated were coagulase-negative Staphylococci in 6/14 (42.8%), Staphylococcus aureus in 5/14 (35.7%), Streptococcus sp in 2/14 (14.2%) and Bacillus sp in 1/14 (7.14%). In addition to vancomycin, resistance to multiple drugs (three or more groups of antibiotics) was found in all 14 cases. Antimicrobial susceptibility results showed susceptibility to amikacin in 7/14 (50.0%), gatifloxacin in 6/14 (42.8%), moxifloxacin in 3/13 (23.0%), cefazoline in 5/14 (35.7%), cefuroxime in 3/14 (21.4%), ciprofloxacin in 2/14 (14.2%) and linezolid in 5/5 (100%). The mean duration of follow-up was 30.7 weeks (6 weeks–90 weeks). At last follow-up, visual acuity (VA) of 20/200 or better was recorded in 7/14 (50%) and VA < 5/200 occurred in 7/14 (50%). Conclusion and importance: Antimicrobial susceptibility testing may help in selection of suitable antimicrobial agents for repeat intravitreal injection. Inspite of retreatment with intravitreal antibiotics, these patients generally had poor VA outcomes. Keywords: Coagulase-negative Staphylococci, Endophthalmitis, Linezolid, Vancomyci

Endophthalmitis caused by gram-positive bacteria resistant to vancomycin: Clinical settings, causative organisms, antimicrobial susceptibilities, and treatment outcomes

To report the clinical settings, causative organisms, antimicrobial susceptibilities, and treatment outcomes of patients with endophthalmitis caused by gram-positive bacteria resistant to vancomycin. Retrospective case series of all patients with culture-proven endophthalmitis caused by gram-positive bacteria resistant to vancomycin between January 2010 and December 2016 in LV Prasad Eye Institute, Visakhapatnam, India. The current study included 14 patients. The clinical settings were post-cataract surgery in 8/14 (57.1%) and open globe injury in 6/14 (42.8%). Primary intervention for all patients included tap and intravitreal antibiotic injection. During subsequent follow-up, pars plana vitrectomy was performed in 6 patients and one patient underwent penetrating keratoplasty. Mean number of intravitreal antibiotic injections performed were 3.4 per patient. The most common organisms isolated were coagulase-negative in 6/14 (42.8%), in 5/14 (35.7%), sp in 2/14 (14.2%) and sp in 1/14 (7.14%). In addition to vancomycin, resistance to multiple drugs (three or more groups of antibiotics) was found in all 14 cases. Antimicrobial susceptibility results showed susceptibility to amikacin in 7/14 (50.0%), gatifloxacin in 6/14 (42.8%), moxifloxacin in 3/13 (23.0%), cefazoline in 5/14 (35.7%), cefuroxime in 3/14 (21.4%), ciprofloxacin in 2/14 (14.2%) and linezolid in 5/5 (100%). The mean duration of follow-up was 30.7 weeks (6 weeks-90 weeks). At last follow-up, visual acuity (VA) of 20/200 or better was recorded in 7/14 (50%) and VA < 5/200 occurred in 7/14 (50%). Antimicrobial susceptibility testing may help in selection of suitable antimicrobial agents for repeat intravitreal injection. Inspite of retreatment with intravitreal antibiotics, these patients generally had poor VA outcomes