PREVALENCE OF ORAL CANDIDIASIS AMONG CANCER PATIENTS ATTENDING A TERTIARY CARE HOSPITAL IN RANCHI, EAST INDIA: A RETROSPECTIVE STUDY.

Background: Within the past two decades, Candida species have emerged as major human pathogens and are currently the fourth most common cause of nosocomial infection. Propose of this study was to determine the occurrence of oral Candidiasis among cancer patients at Rajendra Institute of Medical Sciences, Ranchi. Materials and Methods: Sixty cancer patients were examined for oral candidiasis. For all patients, the clinical diagnosis had to be confirmed microbiologically by the presence of yeasts and/or hyphae or pseudohyphae on potassium hydroxide– treated smears of oral swabs. Oral samples were obtained and cultured on Sabouraud's dextrose agar and CHROMagar. Results: 25 out of the 60 patients (41.7%) were males and 35 (58.3%) were females ranging in age from 15 to 79 years. Gastrointestinal cancer and Breast cancer were the most frequent cancer in the studied group, accounting for 65 % and 18.4 % respectively. The mean weight of the patients was 52.67 Kg (range, 38– 80 Kg). Similarly, the mean of hospital stay was 3.58 days (range; 1-9 days). From these patients, 19 Candida spp were isolated; C. albicans alone outnumbered other species and accounted for 73.68% of episodes of trash. For C. albicans isolates, the MIC values range from 1 to 9 µ g / ml µg / ml for polyenes and from 0.03 to 16 µ g / ml for the azole antifungals. All the Candida albicans had closely related MFCs values. Conclusion: In conclusion, the finding of our study strongly suggests that oral candidiasis is a frequent complication among cancer patients, being C. albicans as the main etiological agent

A RETROSPECTIVE STUDY ON MULTI DRUG RESISTANT TUBERCULOSIS IN A TERTIARY CARE HOSPITAL: AN ALARMING THREAT OF CONCERN.

Introduction: MDR-TB is becoming a significant global health concern in this era. Globally, the incidence of MDR-TB is 3.4% in new cases and 18% in previously treated cases. MDR-TB mostly arises due to inadequate treatment, poor compliance to drugs, and/or direct contact with an MDR-TB patient and hence is essentially a man-made phenomenon. The prevalence of MDR-TB in any area is mirrored by the functional state and efficiency of tuberculosis control programs running in the country. Material and Method:  A total of 549 cases were recruited during the period from 2017 to 2019 and the data were analysed retrospectively. Both pulmonary and extra-pulmonary samples were collected with proper aseptic measures. Direct microscopy by Ziehl Neelsen (ZN) staining was done. Further liquid culture and first-line drug susceptibility testing were performed in MGIT 960. Result: Out of 549 enrolled cases, 312 Mycobacterium tuberculosis cases were confirmed. The prevalence of mono or multi-drug resistance of MTB patients to 1st line drugs during 2017, 2018, and 2019 were 51.7%, 52.1%, and 49.1% respectively. The present study showed a prevalence of MDR-TB in new cases and of previously treated TB cases on an average of 2.7% and 11.2% which is slightly lower than the national level data of 3.4% and 18% respectively. Conclusion: India is showing an increased prevalence of MDR-TB which leads to the greatest obstacle to the End TB strategy adopted by WHO and the government of India. There is an urgent need for continuous surveillance of MDR-TB

SPECTRUM OF OPPORTUNISTIC FUNGAL INFECTIONS IN HIV/AIDS PATIENTS IN TERTIARY CARE HOSPITAL, JHARKHAND, EAST INDIA.

Background: HIV infection continues to be a major health problem with more than millions of AIDS-related death annually. As CD4+ cell count decreases in HIV/AIDS patients, the risk of opportunistic fungal infections increases resulting in high morbidity and Mortality. The spectrum of opportunistic fungal infections varies from one region to another. The purpose of the study was to investigate the occurrence of opportunistic fungal infection among HIV/AIDS-positive patients in Jharkhand. Method: This descriptive study was carried out at a tertiary care center in Jharkhand, over a period of two years. Total 118 HIV-positive patients with CD4+ count ≤200 cells/mm3 and suspected of having fungal infections were included. Samples were collected after taking an informed written consent from the patient. Isolation and identification of organisms were done as per standard Microbiological procedure. Result: Opportunistic fungal infection was identified in 47.45 % of patients. The most common fungi isolated were Candida species, Cryptococcus neoformans, Aspergillus species and Dermatophytes respectively being 27.96 % (n= 33), 12.71% (n= 15), 3.38 % (n= 4) and 3.38 % (n= 4). The commonest fungal agent is Candida species, comprising 58.92 %, followed by Cryptococcus neoformans 28.78 % of total fungal isolates. Conclusion: The common fungus isolated were Candida species, Cryptococcus neoformans, Aspergillus species, and Dermatophytes in HIV-positive patients in Jharkhand. This study would help to sensitize clinicians to make the correct diagnosis and plan appropriate strategies for the investigation and treatment of common opportunistic fungal infections at center

ASSESSMENT OF SPECIATION AND ANTIFUNGAL SUSCEPTIBILITY TESTING IN THE INTENSIVE CARE UNIT: AN OBSERVATIONAL CROSS-SECTIONAL STUDY DESIGN.

Objectives:  This study aims to investigate the epidemiology of Candidemia in patients admitted to Intensive Care Units (ICUs), focusing on the distribution of species, antifungal susceptibility patterns, and demographic factors.  Methods:  The study was carried out for 1 year at the Department of Microbiology, Rajendra Institute of Medical Sciences in Jharkhand, India, and collected 817 blood samples from ICU-admitted patients with signs of sepsis. Using various tests, including germ tube tests and MALDI-TOF mass spectrometry, the study identified Candida species and conducted antifungal susceptibility tests with the VITEK-2 system. The results, categorized as vulnerable, intermediate, or resistant, provided insights into the incidence rates and sensitivity of Candidemia in the studied population.  Results:  The study revealed a Candidemia incidence of 9.57 % among 292 positive blood cultures from ICU-admitted patients. Non-candida albicans predominated at 71.42 %, with Candida tropicalis species encompassing over 28.57 % of the cases. Antifungal susceptibility testing showed all species were vulnerable to the antifungals employed in this study, with C. krusei displaying innate resistance to fluconazole.  Conclusion:  This study highlights the changing epidemiology of Candidemia, with a notable rise in non-candida albicans species, especially in pediatric patients, particularly infants. Despite these shifts, the identified Candida isolates demonstrated overall susceptibility to tested antifungals, emphasizing the significance of precise species-level confirmation and antifungal vulnerability testing for tailored therapeutic approaches in the ICU setting.  Recommendation:  This study recommends continuous monitoring of local Candida species distribution, presumptive identification, and confirmation for early empirical therapy. Moreover, coupled with regular antifungal susceptibility testing to enhance treatment outcomes in vulnerable patient populations

Study the antimicrobial agents sensitivity of methicillin resistant Staphylococcus aureus isolated from patients admitted in RIMS, Ranchi

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of hospital-acquired infections that are becoming increasingly difficult to combat because of emerging resistance to all current antibiotic classes. For this, study of MRSA isolated from admitted patients were carried out. These strains were separately tested for their sensitivity to different antibiotics to know which group of antibiotics are most effective particularly for cases of RIMS, Ranchi. Material & Methods: The present study was carried out in the Department of Microbiology, Rajendra Institute of Medical Sciences (RIMS), Ranchi clinical isolates of MRSA strains were obtained from admitted patients of RIMS, Ranchi. The sources of isolate included pus from infected surgical wounds, infected burn wounds, conjunctival swab, aural swab, throat swab, vaginal swab, urine etc for microbiological analysis and antimicrobial sensitivity of MRSA. Disc diffusion method was employed. Results: All the 264 cases of staphylococcal species isolated from different clinical specimens were subjected to coagulase test. It was observed that out of 264 strains of staphylococci isolated from different sites 165 strains (62.5%) were coagulase positive and 99 strains (37.5%) were coagulase negative by tube method. It was observed that out of 165 strains of staph. aureus isolated from different clinical samples 64 strains of staph. aureus were resistant to methicillin (38.78%). Maximum isolation of MRSA were from pus 38 (51.35%), followed by throat swab 19 (36.36%), aural swab (14.28%) and conjunctival swab (44.44%). It was observed that out of 165 strains of s. aureus isolated only 64 strains were resistant to methicillin. All strains of MRSA were 100% sensitive to Vancomycin & linezolid. Similarly 92.3% were sensitive to netilmicin, 89.7% to clindamycin, 82.1% to ciprofloxacin, 74.4% to cephotaxime, 69.2% to azithromycin, 56.4% to roxithromycin & clarithromycin, 17.9% to piperacillin/tazobactam. The most effective antibiotic against MRSA was vancomycin, linezolid, netilmicin & clindamycin. Conclusion: After comparing the effectiveness of antibiotics against MRSA infection it can be concluded that piperacillin/tazobactam, clarithromycin, roxithromycin azithromycin, cefotaxime & ciprofloxacin are of little value in treating the MRSA infection. They should not be used indiscriminately and in a haphazard manner otherwise increment in emergence of resistant strains may not be checked

Clinicopathological observations on incidental appendicectomy in a tertiary care teaching hospital, Ranchi

Background: Incidental appendectomy is defined as the removal of a clinically normal appendix during non-appendiceal surgery.  This study was conducted at RIMS, Ranchi to document effects of incidental appendicectomy on overall morbidity and mortality while performing the intra-abdominal operation and also to study the frequency of pathological findings in incidentally removed appendices and the correlation between the pathology in the appendix with known aetiological factors for acute appendicitis. Materials & Methods: The diagnosis of the primary intra-abdominal pathology was made on the basis of a detailed history through clinical examination, supported by laboratory investigations and confirmed during operation besides, the patients. The clinical setting-emergency or elective laparotomy in which the appendix was removed was noted. Laparotomy incision used was noted with regard to the case with which the appendix could be approached. The naked eye examination of the appendix was noted. A piece of appendix was collected for histopathological examination. Results: About 42% of patients were below 30 years of age. Approximately 68% of female patients were below 40 years of age. Diseases of the extra-hepatic biliary tree were the most frequent indications for operation in female patients (91%).  Contaminated operations formed 88% of abdominal operations. Appendix could be easily approached and removed in 90% of the laparotomies. Operative time (length of anaesthesia) was increased by an average of 7.7 minutes. Retrocaecal position was the commonest site of appendix (68%). Length of appendices varied between 2.5-15 cms, majority being about 5-10 cms in length. Fibrotic changes with luminal obliteration were observed in 15% of appendices. Faecoliths alone or with bands, kings, adhesions or thickening of wall of appendix were present in 12% cases. Evidence of focal or catarrhal appendicitis was evident in 3% cases. Post-operative hospital stay was 12 days or less in the majority of patients (93%). Conclusion: An incidental appendicectoy should be performed when operating in abdomen for the surgical treatment of some other diseases, where no contraindication exists. The added procedure does not increase either intra-operative risk or post-operative complications and spares the patient from the possible subsequent development of acute appendicitis

Comparison of proximal femur locking compression plate with dynamic hip screw in management of inter-trochanteric fracture

Background: Intertrochanteric fractures are common in elderly population and pose a significant financial burden to the patients and family. Anatomically contoured proximal femur locking compression plate (PFLCP) is the latest addition to deal with these fractures, which creates an angular stable construct. It will theoretically lessen the risk of failure by screw cut-out and varus collapse, the common mode of DHS failure. Materials & Methods: This study was done to prospectively compare, the rate of union, complications, operative risks and functional outcomes in inter-trochanteric fractures treated with dynamic hip screw [DHS] and Proximal femur locking compression plate [PFLCP]. It also determined the effectiveness of PF-LCP in comparison to DHS in treatment of inter-trochanteric fractures. The data collected during the study of 30 cases of inter-trochanteric fractures, 15 cases were treated using PFLCP and other 15 group of cases were treated using DHS in the Department of Orthopaedics in Rajendra Institute of Medical Sciences, Ranchi from December 2012 to December 2014.Results: The functional outcome was measured with Harris Hip Score. In PFLCP group 7 (46.67%) cases had excellent result, 5 (33.33%) cases had good result, and 3 (20%) cases had fair result with no poor result. The mean score in PFLCP group was 86.4. In DHS group 7 (46.67%) cases had excellent result, 4 (26.67%) cases had good result, 2 (13.33%) cases had fair result and 2 (13.33%) cases had poor result. Conclusion: PFLCP is a good option for the management of inter-trochanteric fracture with high union rate and low rate of complication with high functional outcome and with a possibility that it can be done without C-Arm

Prevalence of intestinal parasites in HIV/AIDS-infected patients with correlation to CD4+ T-cell count at hospital in Eastern India

Introduction: In developing nations, one of the most common reasons for death and illness is due to infections that are brought on by intestinal parasites. People who have HIV are more likely to contract parasites that are either well-established intestinal pathogens, like Entamoeba histolytica, Giardia lamblia and Strongyloidesstercoralis, or an opportunistic pathogen like Cryptosporidium, Isospora, Cyclospora and Microsporidia. Higher prevalence of intestinal parasitic infections occurs in patients with low CD4+ cell counts. Hence, this study had been performed to know the correlation of intestinal parasitic infection in HIV/AIDS patients with reference to CD4+ cell count. Materials and Methods: The study comprised 1477 HIV-positive patients who were treated at ART Centre of Rajendra Institute of Medical Sciences (RIMS), Ranchi. All participants provided verbal informed consent before specimens were collected. Blood and stool sample were used for the identification of parasite and CD4+ T-Cell count. Results: In patients living with HIV, the prevalence of intestinal parasite infection was 12.59 per cent. In a manner parallel, the prevalence of parasitic infections was found to be 10.29% among male HIV-positive patients and 2.31% among female HIV-positive patients. Conclusions: This study has shed light that low CD4+ T-cell count appears to be a factor for intestinal parasitic infections and development of diarrhoea. Regular screening and treatment of intestinal parasitic infections is very important in overall improvement in quality of life of HIV/AIDS patients. Nevertheless, sanitary hygiene practices and deworming are needed to enhance the control of infection in the affected areas

Comparison of the clinical effectiveness and intraoperative and postoperative complications of proximal femur locking compression plate (PFLCP) with dynamic hip screw (DHS) in the management of inter-trochanteric fracture

Background: Intertrochanteric femur fractures are a very common injury seen in the elderly. Understanding the pathophysiology as well as the proper treatment options will significantly decrease the risk of mortality and morbidity of this injury. Anatomically contoured proximal femur locking compression plate (PFLCP) is the latest addition to deal with these fractures, which creates an angular stable construct. It will theoretically lessen the risk of failure by screw cut-out and varus collapse, the common mode of DHS failure. Hence here we intended to study these two implants in inter-trochanteric fracture management regarding its clinical effectiveness and intraoperative and postoperative complications. Materials & Methods: This study was done to prospectively compare, the rate of union, complications, operative risks and functional outcomes in inter-trochanteric fractures treated with dynamic hip screw (DHS) and Proximal femur locking compression plate (PFLCP). It also determined the effectiveness of PF-LCP in comparison to DHS in treatment of inter-trochanteric fractures. The data collected during the study of 30 cases of inter-trochanteric fractures, 15 cases were treated using PFLCP and other 15 group of cases were treated using DHS in the Department of Orthopaedics in Rajendra Institute of Medical Sciences, Ranchi from December 2012 to December 2014. Results: The functional outcome was measured with Harris Hip Score. In PFLCP group 7 (46.67%) cases had excellent result, 5 (33.33%) cases had good result, and 3 (20%) cases had fair result with no poor result. The mean score in PFLCP group was 86.4. In DHS group 7 (46.67%) cases had excellent result, 4 (26.67%) cases had good result, 2 (13.33%) cases had fair result and 2 (13.33%) cases had poor result. The mean score in DHS group was 83.4, although the PFLCP had better results but the difference between the two groups was not statistically significant P-value >0.05. In PFLCP group there was varus malunion in 3 (20%) cases, shortening >2cm in 2 (13.33%) cases. Delayed union was seen in 2 (13.33%) cases. No case of non union was seen. No case had Infection, bed sore, deep venous thrombosis and death. In 5 (33.33%) cases we failed to accommodate all three screws. There was no incidence of plate breakage or screw cut out. In DHS study group there were 4 (26.67%) cases with improper placement of the lag screw, shortening in 4(26.67%) cases and rotational deformity in 2(13.33%) case. Post operative superficial infection was seen in 2(13.33%) case. No case had deep venous thrombosis or death. Varus malunion was seen in 3(20%) cases and delayed union in 2(13.33%) cases, no case of non union was seen. Implant failure was seen in 1 case with screw breakage. Conclusion: PFLCP is a good option for the management of inter-trochanteric fracture with high union rate and low rate of complication with high functional outcome and with a possibility that it can be done without C-Arm

Microbiological and Biochemical Analysis of Methicillin-resistant Staphylococcus aureus Isolated from Patients Admitted in RIMS, Ranchi

Background: Since methicillin-resistant Staphylococcus aureus strains are resistant to multiple antibiotics, there is a possibility of extensive outbreaks which may be difficult to control. Early detection of methicillin-resistant Staphylococcus is important from patients and hospitals point of view. Materials and Methods: The present study was carried out in the Department of Microbiology, Rajendra Institute of Medical Sciences, Ranchi, clinical isolates of methicillin-resistant S. aureus strains were obtained from admitted patients of Rajendra Institute of Medical Sciences, Ranchi. The sources of isolate included pus from infected surgical wounds, infected burn wounds, conjunctival swab, aural swab, throat swab, vaginal swab, and urine for microbiological and biochemical analysis of methicillin-resistant S. aureus. Results: All the 264 cases of staphylococcal species isolated from different clinical specimens were subjected to coagulase test. It was observed that out of 264 strains of staphylococci isolated from different sites, 165 strains (62.5%) were coagulase positive and 99 strains (37.5%) were coagulase negative by tube method. Out of the 165 strains of coagulase-positive staphylococci, maximum isolation was obtained from pus 74 followed by throat swab 55, aural swab 21, vaginal 4, conjunctival swab 9, and urine 2. All the 165 cases of coagulase-positive Staphylococcus isolated from different clinical specimens were studied for hemolysis, mannitol fermentation, pigment production, and phosphatase production. Out of these 165 strains, 162 (98%) strains produced β-hemolysis on blood agar medium. Pigment production was noted in 160 (97%) of cases. Majority of strains produced characteristic golden yellow pigment on nutrient agar plate. A total of 155 (94%) strains of staphylococci fermented mannitol with the production of acid only. Phosphatase production was observed in 157 (95%) strains of pathogenic staphylococci. Conclusion: Considering the above-mentioned pathogenicity test, it was observed that coagulase test was the single most reliable test, though coagulase-negative staphylococci are sometimes pathogenic too