Medical student’s perception and feed-back on virtual classes during COVID-19 pandemic: a multi-centric questionnaire based study

Introduction: The quick turn to online platforms from contact learning during COVID-19 remained challenging for both teachers as well for students. This study was done with the aim to know the perception and feed back of under-graduate medical students on virtual classes during the pandemic. Material & Methods: This was a cross-sectional questionnaire based multi-centric study.  Questionnaire in the form of Google form was distributed to the undergraduate medical students from various MBBS professionals studying in various medical colleges across North India. The completed questionnaire was collected and data was analyzed. Results: 40% students were from government, 52% from private medical colleges and 8% from AIIMS/ SGPGI. Majority of students were using mobile (63.7%) for e learning, using 4G internet (70.6%). Mostly the private medical colleges (73%) and only 4.5% government colleges were conducting the live video classes. Rest of them was providing the soft copy of the study material to the students. Based on the feedback by the students, about one third of the students (36.7%) appreciated the online platform in the current scenario as well for future in the combination with traditional classroom teaching. Discussion: The e-learning was the need of the hour as every day is important for a medical student and the learning has to be uninterrupted. Although helpful, e-learning alone is a far cry from face‐to‐face interaction between students and teachers. Finding the right balance of class-room teaching combined with e-learning should become the norm for future students.   &nbsp

SERUM HOMOCYSTEINE AS A RISK FACTOR FOR STROKE: A PROSPECTIVE STUDY FROM A RURAL TERTIARY CARE CENTRE

Objective: Stroke is one of the leading causes of mortality and long-term disability in both developed and developing countries. Serum homocysteine level is one of the emerging modifiable risk factors for atherosclerosis which may result into a cerebrovascular accident. This study was designed to study the association of Serum Homocysteine level with the development of acute stroke at a rural tertiary care centre in North India.Methods: The present study was a prospective cross-sectional study conducted in the Department of Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. The study population included 100 patients presenting with Stroke (either ischemic or hemorrhagic) in the indoor and outdoor facilities in the Department of Medicine. 50 age and sex-matched healthy individuals were taken as controls. Serum total Homocysteine level was measured in all the cases and controls.Results: Majority of the patients suffered from ischemic stroke (78%), while only 22% patients had hemorrhagic stroke. The mean Serum Homocysteine level in stroke patients (19.88±8.78 μmol/l) was significantly higher than in controls (10.48±4.39 μmol/l) (p<0.01). In a subgroup analysis, stroke patients with a positive history of smoking had significantly higher homocysteine level as compared to non-smokers (p<0.05).Conclusion: Increased level of Serum Homocysteine is significantly associated with risk of cerebrovascular accident, which is independent of the risk attributed to traditional risk factors.Â

Therapeutic options for extended-spectrum β-lactamases (ESBLs), AmpC β-lactamases producing Escherichia coli and Klebsiella sp. isolated from various clinical samples

Escherichia coli and Klebsiella sp. are the predominant species isolated from clinical samples. Recent and proper understanding of the antibiotic susceptibility pattern of extended-spectrum β-lactamases (ESBL) and AmpC β-lactamases (AmpC) producing E. coli and Klebsiella sp. will prevent the distribution and future incidence of ESBL and AmpC. We designed this study to understand antibiotic susceptibility patterns of ESBL and AmpC producing E. coli and Klebsiella sp. isolated from a tertiary care hospital in North India. A cross-sectional study was conducted from March 2021 to February 2022. Guring this period, various clinical samples were collected and further tested for ESBL producing E. coli and Klebsiella sp. by using the Double disc Synergy test, whereas AmpC was detected by the Boronic acid disk potentiation method. Their antibiotic susceptibility patterns were noted. Various clinical specimens were collected, in which 37.95% were shown growth of bacteria. Among them, 46.67% of E. coli and 25.21% of Klebsiella sp. were identified by standard laboratory protocol. ESBL producing isolates were 44.37% and 34.20% in E. coli and Klebsiella sp., respectively. Whereas AmpC production was detected in 18.27% of E. coli and 29.36% of Klebsiella sp. ESBL and AmpC producing E. coli and Klebsiella sp. isolated from pus, blood, and sputum samples showed the highest sensitivity towards colistin, tigecycline, and imipenem while in urine samples imipenem, meropenem showed the highest sensitivity. Susceptibility patterns of ESBL and AmpC producing E. coli and Klebsiella sp. from various clinical specimens enhance hospital infection management and help clinicians to prescribe the appropriate antibiotics. The carbapenem, nitrofurantoin, colistin and tigecycline were showed highest susceptible against ESBL and AmpC producing E. coli and Klebsiella sp

Non-Fermenting Gram Negative Bacteria in blood culture: A menace in intensive care unit settings: Non-Fermenting Gram Negative Bacteria

Introduction: One of the major cause of blood stream infections (BSI) are non-fermenting Gram-negative bacilli (NFGNB) which results in increased morbidity and mortality in patients Aim: To know the prevalence of NFGNB isolated from blood culture specimens and their antibiotic sensitivity pattern in intensive care units. Material and Methods: A total of 3393 blood samples during one year were received from patients admitted in various ICUs. 5-7 mL blood was aseptically collected and added in BACTEC bottles and then subsequently incubated in BD BACTECTM (FX40) fluorescent series instrument for up to five days. After incubation period positive samples were processed for gram stain and subsequently subcultured on blood agar and MacConkey agar. These plates were incubated at 37oC for 24 hours. Further identification and antimicrobial susceptibility testing of NFGNB was carried out by Vitek-2 Compact (Biomerieux India) as per the standard operating procedures. Results: Out of 3393 samples 696 samples showed growth, out of which 96 (13.79%) were Gram positive cocci (GPC), 36 (5.17%) were Candida spp. and 564 (81.03%) were Gram negative bacilli. Among 564 GNB, 453(80.31%) were Lactose fermenter and 111(19.68%) were Non-lactose fermenters. 1 (0.53%) isolate of Aeromonas hydrophila were excluded from this study. Among 110 NFGNB, Acinetobacter baumannii Complex (41.66%) was the most predominant followed by Pseudomonas aeruginosa (32.72%). Amikacin was the most sensitive drug for all the NFGNB isolates followed by Piperacillin/Tazobactam. Stenotrophomonas maltophilia showed excellent susceptibility to minocycline (83.33%) followed by ceftazidime (66.66%). Burkholderia cepacia showed good susceptibility to Trimethoprim/Sulfamethoxazole. Conclusion: Increasing antimicrobial resistance in NFGNB and their intrinsic or acquired resistance to many antibiotics makes them more lethal. It is therefore recommended to have quality guidelines on the ‘rational use of antibiotics’ which need to be implemented strictly

In vitro Antibacterial Potency of Leaf Extract of Moringa oleifera against NFGNB Isolated from UTI Patients and their Plasmid Profiling

Non-fermenting gram-negative bacteria (NFGNB) endeavouring as major pathogen in infectious disease, predominantly in urinary tract infection (UTI) and increased resistance in NFGNB are matter of concern. This study aimed to evaluate the frequency of NFGNB, antibiotics resistance pattern, plasmid profiling, and antibacterial efficacy of Moringa oleifera against NFGNB. NFGNB were isolated from clinically suspected UTI patients. Identification of isolates and their antibiotics sensitivity pattern were analyzed according to conventional method, and Vitek 2 automated system. Moreover, NFGNB were evaluated for biofilm production and presence of plasmid. Furthermore, antibacterial activity of Moringa oleifera was evaluated against NFGNB. P. aeruginosa (86.0%), and A. baumannii (10.0%) were the most frequent NFGNB followed by Providencia rettgeri 2.0%, Stenotrophomonas maltophilia 1.0%, myroides species 1.0%. 68.6% P. aeruginosa and 60.0% A. baumannii were biofilm producers whereas imipenem and meropenem were the most effective antibiotics. Isolated NFGNB showed multiple bands of plasmid. Furthermore, Moringa oleifera leaves extract showed antibacterial activity against tested NFGNB. MDR-NFGNB presents challenges in treatment and Moringa oleifera leaf extract may be used as an alternative medicine. However, the therapeutic role of specific ingredients present in extract needs further investigation and purification

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)