Assessment of knowledge, attitude and practices of universal precautions among medical and nursing students

Background: Universal precautions is an approach to infection control to treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other bloodborne pathogens. The CDC recommends Standard Precautions for the care of all patients, regardless of their diagnosis or presumed infection status. Health care personals are at risk of being exposed to blood-borne pathogens. The aim of the study to determine the knowledge, attitude and practice of medical and nursing students towards universal precautions.Methods: A cross-sectional survey was carried out at S. S. Institute of Medical Sciences and Research Centre, Davangere, Karnataka. The participants were medical and Nursing undergraduate students. A questionnaire was prepared based on the WHO and CDC guidelines on Universal Precautions and was validated and pre-tested before finalization. Degree of knowledge was ascertained by means of yes-no questions on each item being evaluated.Results: All students were aware of Universal precautions, but soundness of their knowledge is very poor. Compliance in Universal precautions is good to average in nursing students but poor to average in medical students.Conclusions: It can be concluded that interventions to improve Universal precautions among medical students, nursing students urgently needed. So, there is a need for developing strategies to promote the use of Universal precautions which take into account behaviour change and accuracy of knowledge including its integration into practice. Teaching universal precautions early in their curriculum is necessary for better learning and practices during their posting

Public transport: a large scale fomite of methicillin-resistant Staphylococcus aureus

Background: The role of public transport as reservoirs of antibiotic-resistant staphylococci was determined.Methods: 200 swabs were collected from 50 public buses (urban and rural) circulating in Davangere, Karnataka. Swabs collected were inoculated on Blood agar, Mannitol salt agar and MacConkey agar plates. After incubation for 24-48 hours, plates were examined for the growth of Staphylococcus aureus. Anti-microbial susceptibility test was performed using oxacillin 1ug disc to detect methicillin resistance as per CSLI guidelines.Results: Out of 40 Staphylococcus aureus isolated 35 isolates were resistant to more than two classes of antibiotics, hence multidrug resistant Staphylococcus aureus. Out of 35 MDR isolates, 18 were resistant to oxacillin and cefoxitin. Minimum inhibitory concentration test revealed that out of 35 MDR isolates, 18 isolates had MIC value of ≥ 4µg/ml.Conclusions: The recovery methicillin-resistant Staphylococcus aureus from public transport system implies a potential risk for transmission of these bacteria in community

Rickettsial neglected zoonoses: prevalence of scrub typhus at central Karnataka

Background: Fever of unknown Origin (FUO) has many multiple causes such as enteric fever, malaria, dengue, tuberculosis, brucellosis. But scrub typhus is less known cause in Indian scenario. The present study reports the prevalence of scrub typhus at central Karnataka and compares the sensitivity and specificity of Weil-Felix test and the IgM ELISA in the detection of infection.Methods: 368 serum samples of FUO cases were collected. Weil-Felix test was performed and also analyzed for IgM antibodies to Orienta tsutsugamushi by IgM ELISA test along with haematological and biochemical investigations.Results: Out of 368 patients of fever of unknown origin, 94 cases were positive by OXK antigens by Weil Felix test and 61 were positive by ELISA test for ST IgM antibodies. Fever was the most common clinical presentation occurring in ST IgM ELISA positive cases, followed by myalgia in 90.1% cases, headache in 77%, hepatomegaly in 65.5%, splenomegaly in 62.2% and rashes were seen in 29.5% patients. Eschar was seen in 13.1% patients, pneumonia in 3.2% and meningo-encephalitis in 1.6%. Sensitivity and specificity of WFT in relation to IgM ELISA at a titre of 160 was 81.97% and 85.67% respectively.Conclusions: With the growing number of cases detected in India, scrub typhus is fast emerging as a public health threat and also due to limited diagnostics leading to underreporting, Weil Felix test could be used in adjunct with Enzyme-linked immunosorbent assay and blood parameters in the diagnosis of rickettsial diseases

Repercussion of biofilm and antibiotic resistance in ventilator associated pneumonia

Background: Ventilator associated pneumonia contributes nearly half of all cases of hospital-acquired pneumonia. Drug resistance among ventilator associated pneumonia has obligation of device withdrawal in order to achieve clinical and microbiological cure. Aim of the study was to determine the relationship between antibiotic resistance of Endotracheal tube biofilm and pulmonary pathogens in ventilator-associated pneumonia.Methods: A descriptive analytical study of 100 clinically suspected VAP patients was done. Patients were divided into group-I and Group-II based on intubation duration for 1-5 days and 6-10 days respectively. Endotracheal aspirate (ETA) was collected from clinically diagnosed cases and processed as per standard microbiological techniques. Bacterial counts ≥106 CFU/ml for quantitative cultures was considered significant. Biofilm production was detected by tissue culture plate, tube method and Congo red method. Multi-variant analysis was done to find out the association of the various factors.Results: Klebsiella pneumoniae was the predominant bacteria isolated followed by Acinetobacter baumannii. 45% of Gram negative bacteria were β lactamase producers. In Biofilm production by tissue culture method, 72% of the isolates showed either strong or moderate biofilm formation. Multivariate analysis revealed that bacteria isolated from VAP occurring after 5 days of mechanical ventilation among prior antibiotic-treated patients were resistant to all the antibiotics tested.Conclusions: Bacterial aetiology, biofilm formation and drug resistance has ramification on outcome of ventilator associated pneumonia. Hence, advised that it is crucial to remove ET tube in regular interval to prevent biofilm formation and sequential cultures to obtain the microbiological information which enables better patient care.

Retinal changes in Alzheimer's disease— integrated prospects of imaging, functional and molecular advances

Alzheimer's Disease (AD) is a devastating neurodegenerative disorder of the brain, clinically characterised by cognitive deficits that gradually worsen over time. There is, at present, no established cure, or disease-modifying treatments for AD. As life expectancy increases globally, the number of individuals suffering from the disease is projected to increase substantially. Cumulative evidence indicates that AD neuropathological process is initiated several years, if not decades, before clinical signs are evident in patients, and diagnosis made. While several imaging, cognitive, CSF and blood-based biomarkers have been proposed for the early detection of AD; their sensitivity and specificity in the symptomatic stages is highly variable and it is difficult to justify their use in even earlier, pre-clinical stages of the disease. Research has identified potentially measurable functional, structural, metabolic and vascular changes in the retina during early stages of AD. Retina offers a distinctively accessible insight into brain pathology and current and developing ophthalmic technologies have provided us with the possibility of detecting and characterising subtle, disease-related changes. Recent human and animal model studies have further provided mechanistic insights into the biochemical pathways that are altered in the retina in disease, including amyloid and tau deposition. This information coupled with advances in molecular imaging has allowed attempts to monitor biochemical changes and protein aggregation pathology in the retina in AD. This review summarises the existing knowledge that informs our understanding of the impact of AD on the retina and highlights some of the gaps that need to be addressed. Future research will integrate molecular imaging innovation with functional and structural changes to enhance our knowledge of the AD pathophysiological mechanisms and establish the utility of monitoring retinal changes as a potential biomarker for AD

Evaluation of Jute as a Reinforcement in Composites

87-92<span style="font-size:11.0pt;line-height:115%; font-family:" calibri","sans-serif";mso-ascii-theme-font:minor-latin;mso-fareast-font-family:="" "times="" new="" roman";mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:="" minor-latin;mso-bidi-font-family:"times="" roman";mso-ansi-language:en-us;="" mso-fareast-language:en-us;mso-bidi-language:ar-sa"="">A detailed evaluation of jute fibres for use in polymer composites has been made. The mechanical properties, thermal stability, moisture absorption and resin consumption of jute fibres have been studied. Methods for reducing moisture absorption and resin consumption are reported.</span

Isolation of bacteriophages to multi-drug resistant Enterococci obtained from diabetic foot: A novel antimicrobial agent waiting in the shelf?

Introduction: While foot infections in persons with diabetes are initially treated empirically, therapy directed at known causative organisms may improve the outcome. Many studies have reported on the bacteriology of diabetic foot infections (DFIs), but the results have varied and have often been contradictory. The purpose of the research work is to call attention to a frightening twist in the antibiotic-resistant Enterococci problem in diabetic foot that has not received adequate attention from the medical fraternity and also the pharmaceutical pipeline for new antibiotics is drying up. Materials and Methods: Adult diabetic patients admitted for lower extremity infections from July 2008 to December 2009 in the medical wards and intensive care unit of medical teaching hospitals were included in the study. The extent of the lower extremity infection on admission was assessed based on Wagner′s classification from grades I to V. Specimens were collected from the lesions upon admission prior to the initiation of antibiotic therapy or within the first 48 h of admission. Results: During the 18-month prospective study, 32 strains of Enterococcus spp. (26 Enterococcus faecalis and 06 E. faecium) were recovered. Antibiotic sensitivity testing was done by Kirby-Bauer′s disk diffusion method. Isolates were screened for high-level aminoglycoside resistance (HLAR). A total of 65.6% of Enterococcus species showed HLAR. Multidrug resistance and concomitant resistance of HLAR strains to other antibiotics were quite high. None of the Enterococcus species was resistant to vancomycin. Conclusion: Multidrug-resistant Enterococci are a real problem and continuous surveillance is necessary. Today, resistance has rendered most of the original antibiotics obsolete for many infections, mandating the development of alternative anti-infection modalities. One of such alternatives stemming up from an old idea is the bacteriophage therapy. In the present study, we could able to demonstrate the viable phages against MDR E. faecalis