A study of superficial surgical site infections in a tertiary care hospital at Bangalore

Background: All postoperative surgical infections occurring in an operative site are termed surgical site infections (SSI). Superficial incisional surgical site infection occurs within 30 days after the operation and infection involves only skin or subcutaneous tissue of the incision and represents a substantial burden of disease for patients and health services. The study was conducted to know the incidence of surgical site infection in our hospital, risk factors associated with it and the antibiotic susceptibility pattern of the pathogens.Methods:This prospective study was carried out in the Department of Microbiology at Dr B R AMC for a period of 1 year from Jan 2013to Jan 2014. Samples of SSI received in the Microbiology laboratory were processed and Data collected.Results:The overall surgical site infection rate in our hospital during the study period is 4.3%. Staphylococcus aureus (S. aureus) was the most common isolate obtained followed by Escherichia coli (E. coli) and Coagulase negative Staphylococcus (CONS). Other organisms isolated were Pseudomonas aeruginosa, Enterococcus, Klebsiella pneumoniae and Proteus mirabilis. Among them, 88.8% of S. aureus and 50% of CONS isolates were methicillin-resistant strains. 80% of E. coli and 100% of Klebsiella species were ESBL producers. 50% of Enterococci were Vancomycin resistant. Risk factors like diabetes mellitus and duration plays a significant role in causing surgical site infection.Conclusion:Implementation of an effective infection control programme and judicious use of antibiotic prophylaxis reduces the incidence of SSI in the hospital.

A study of biofilm production in clinical isolates of Staphylococci at a tertiary care hospital, Bangalore

Background: The Biofilms are densely packed communities of microorganisms consisting of layers of cell clusters embedded in a matrix of extracellular polysaccharide called polysaccharide intercellular adhesin. This layer impedes the delivery of antibiotics to the biofilm forming microbial cells leading to emergence of drug resistance. Staphylococci are commensal bacteria on the human skin and mucous membranes. So it may be easily introduced as a contaminant during the surgical intervention. So, this study was conducted to identify the Biofilm producing strains from clinical isolates of Staphylococci.Methods: A total of 182 non-repetitive clinical strains of Staphylococci isolated from various clinical samples from Feb 2014 to Oct 2014 were included in the study. All the isolates were identified using standard microbiological procedures. All the samples were tested for biofilm production by modified Congo-red agar method and tube method.Results: Out of 182 samples that were included in the study, a total of 90 (49.45%) samples showed biofilm formation of which 58 (75.32%) were methicillin resistant and 32 (30.47%) were methicillin sensitive. Also these strains were resistant to other antibiotics.  Conclusion: Our study showed biofilm production by methicillin resistant strains which were also multidrug resistant. Treatment of methicillin resistant strains of Staphylococci is one of the most challenging task for the clinicians and the microbiologists. So they should be routinely screened for biofilm formation in order to prevent emergence and spread of multidrug resistant strains.

Speciation of clinically significant coagulase negative staphylococci and their antibiotic resistant patterns in a tertiary care hospital

Background: Coagulase negative Staphylococci (CONS) are normal human microbiota and sometimes cause infections, often associated with implanted devices, such as joint prosthesis, shunts and intravascular catheters, especially in very young, old and immunocompromised patients. These infections are difficult to treat because of the risk factors and the multiple drug resistant nature of the organisms. The study is undertaken to speculate CONS isolates from various clinical samples and to determine antibiotic susceptibility pattern of CONS by Kirby Bauer disc diffusion method.Methods: A total of 134 clinically significant CONS isolated from pus, urine, blood, fluid, sputum, ear swabs, endotracheal tube, ophthalmic, semen and nail samples. These isolates initially identified by colony morphology, Gram staining, catalase test, slide coagulase test, tube coagulase test and mannitol fermentation.Speciation of CONS was done by novobiocin resistance test, urease activity, ornithine decarboxylase and aerobic acid production from mannose.Results: S. epidermidis is the most frequent isolate 62 (46.3%) followed by S. saprophyticus 38(28.4%), S. haemolyticus 27(20.1%), S. lugdunensis 3(2.2%). S. warneri 3(2.2%), S. cohinii 1(0.7%). Antibiotic susceptibility testing of the isolates showed maximum resistance to penicillin 128 (95.5%) and ampicillin118 (88%) followed by erythromycin 96 (71.6%), cefoxitin 89 (66.4%), gentamicin 33(24.6%), piperacillin & tazobactam 31(23.8%), amoxicillin & clavulanic acid 25 (18.7%), linezolid 23 (17.2%), levofloxacin 9 (6.7%), vancomycin & teicoplanin 2 (1.5%), tigecycline 1 (0.7%).Conclusion: S. epidermidis is the more common isolate identified and CONS are often resistant to multiple antibiotics (Penicillin, ampicillin) & glycopeptides have been considered as the drugs of choice for the management of infections caused by these organisms.  

Isolation and speciation of Enterococci from various clinical samples and their antimicrobial susceptibility pattern with special reference to high level Aminoglycoside resistance

Background and Objectives: Enterococci are important nosocomial agents and strains resistant to penicillin and other antibiotics occur frequently. Enterococci are intrinsically resistant to cephalosporins and offer low level resistance to aminoglycosides. In penicillin sensitive strains, synergism occurs with combination treatment with penicillin and aminoglycoside. Serious infections caused by them are treated with penicillin and aminoglycoside combination. But the synergistic effect is lost, when the strain develops high level aminoglycoside resistance. The choice of drug for infections due to such strains is vancomycin. The present study was carried out to isolate and speciate Enterococci from various clinical samples, to know the susceptibility pattern of the isolates, to determine the High Level Aminoglycoside Resistance (HLAR) among Enterococcal isolates. Methods: A total of One hundred Enterococcal species isolated from various clinical samples were identified by various biochemical reactions. Antimicrobial susceptibility testing and HLAR were determined by Kirby- Bauer disc diffusion method. Results: Out of 100 Enterococcal isolates, 59 were E. faecalis, 38 were E. faecium, 3 were other Enterococcal species. Among these 53 isolates showed High Level Aminoglycoside Resistance. Conclusion: Present study shows the presence of drug resistance to most of commonly used antibiotics and HLAR is also more in E.faecium compared to E.fecalis

RenalGuard system in high-risk patients for contrast-induced acute kidney injury.

BACKGROUND: High urine flow rate (UFR) has been suggested as a target for effective prevention of contrast-induced acute kidney injury (CI-AKI). The RenalGuard therapy (saline infusion plus furosemide controlled by the RenalGuard system) facilitates the achievement of this target. METHODS: Four hundred consecutive patients with an estimated glomerular filtration rate ≤30 mL/min per 1.73 m(2) and/or a high predicted risk (according to the Mehran score ≥11 and/or the Gurm score >7%) treated by the RenalGuard therapy were analyzed. The primary end points were (1) the relationship between CI-AKI and UFR during preprocedural, intraprocedural, and postprocedural phases of the RenalGuard therapy and (2) the rate of acute pulmonary edema and impairment in electrolytes balance. RESULTS: Urine flow rate was significantly lower in the patients with CI-AKI in the preprocedural phase (208 ± 117 vs 283 ± 160 mL/h, P 0.32 mg/kg (HR 5.03, 95% CI 2.33-10.87, P < .001) were independent predictors of CI-AKI. Pulmonary edema occurred in 4 patients (1%). Potassium replacement was required in 16 patients (4%). No patients developed severe hypomagnesemia, hyponatremia, or hypernatremia. CONCLUSIONS: RenalGuard therapy is safe and effective in reaching high UFR. Mean intraprocedural UFR ≥450 mL/h should be the target for optimal CI-AKI prevention

Local molecular and global connectomic contributions to cross-disorder cortical abnormalities

Contains fulltext : 253170.pdf (Publisher’s version ) (Open Access

Common Scaling Patterns in Intertrade Times of U. S. Stocks

We analyze the sequence of time intervals between consecutive stock trades of thirty companies representing eight sectors of the U. S. economy over a period of four years. For all companies we find that: (i) the probability density function of intertrade times may be fit by a Weibull distribution; (ii) when appropriately rescaled the probability densities of all companies collapse onto a single curve implying a universal functional form; (iii) the intertrade times exhibit power-law correlated behavior within a trading day and a consistently greater degree of correlation over larger time scales, in agreement with the correlation behavior of the absolute price returns for the corresponding company, and (iv) the magnitude series of intertrade time increments is characterized by long-range power-law correlations suggesting the presence of nonlinear features in the trading dynamics, while the sign series is anti-correlated at small scales. Our results suggest that independent of industry sector, market capitalization and average level of trading activity, the series of intertrade times exhibit possibly universal scaling patterns, which may relate to a common mechanism underlying the trading dynamics of diverse companies. Further, our observation of long-range power-law correlations and a parallel with the crossover in the scaling of absolute price returns for each individual stock, support the hypothesis that the dynamics of transaction times may play a role in the process of price formation.Comment: 8 pages, 5 figures. Presented at The Second Nikkei Econophysics Workshop, Tokyo, 11-14 Nov. 2002. A subset appears in "The Application of Econophysics: Proceedings of the Second Nikkei Econophysics Symposium", editor H. Takayasu (Springer-Verlag, Tokyo, 2003) pp.51-57. Submitted to Phys. Rev. E on 25 June 200

Developments in unsteady pipe flow friction modelling

This paper reviews a number of unsteady friction models for transient pipe flow. Two distinct unsteady friction models, the Zielke and the Brunone models, are investigated in detail. The Zielke model, originally developed for transient laminar flow, has been selected to verify its effectiveness for "low Reynolds number" transient turbulent flow. The Brunone model combines local inertia and wall friction unsteadiness. This model is verified using the Vardy's analytically deduced shear decay coefficient C* to predict the Brunone's friction coefficient k rather than use the traditional trial and error method for estimating k. The two unsteady friction models have been incorporated into the method of characteristics water hammer algorithm. Numerical results from the quasi-steady friction model and the Zielke and the Brunone unsteady friction models are compared with results of laboratory measurements for water hammer cases with laminar and low Reynolds number turbulent flows. Conclusions about the range of validity for the three friction models are drawn. In addition, the convergence and stability of these models are addressed.Anton Bergant, Angus Ross Simpson, John Vìtkovsk

Locating Photography

The specter of global dissemination haunted photography from its very beginning. This chapter explains two aspects of photography's “globalization”: its use as a “western” technique to document an increasingly colonized world and its dissemination around the world and its adoption by local practitioners. In rural and small‐town central India, the studio retains a central place in most people's encounters with photography. Martín Chambi would retain a lifelong adherence to the purity of the photographic image but other indigenista photographers, such as Juan Manuel Figueroa Aznar, would increasingly use paint alongside photography. A World System Photography, seen in networks that fold locally articulated practices into trajectories that fuse technics, history, and culture, can help people think in new ways about the “location” of photography. Locations have to be re‐imagined as “Terra Infirma”, unstable and complex positions which may have more of the quality of linking sections of a network than of territories

Network structure and transcriptomic vulnerability shape atrophy in frontotemporal dementia

Connections among brain regions allow pathological perturbations to spread from a single source region to multiple regions. Patterns of neurodegeneration in multiple diseases, including behavioural variant of frontotemporal dementia (bvFTD), resemble the large-scale functional systems, but how bvFTD-related atrophy patterns relate to structural network organization remains unknown. Here we investigate whether neurodegeneration patterns in sporadic and genetic bvFTD are conditioned by connectome architecture. Regional atrophy patterns were estimated in both genetic bvFTD (75 patients, 247 controls) and sporadic bvFTD (70 patients, 123 controls). First, we identified distributed atrophy patterns in bvFTD, mainly targeting areas associated with the limbic intrinsic network and insular cytoarchitectonic class. Regional atrophy was significantly correlated with atrophy of structurally- and functionally-connected neighbours, demonstrating that network structure shapes atrophy patterns. The anterior insula was identified as the predominant group epicentre of brain atrophy using data-driven and simulation-based methods, with some secondary regions in frontal ventromedial and antero-medial temporal areas. We found that FTD-related genes, namely C9orf72 and TARDBP, confer local transcriptomic vulnerability to the disease, modulating the propagation of pathology through the connectome. Collectively, our results demonstrate that atrophy patterns in sporadic and genetic bvFTD are jointly shaped by global connectome architecture and local transcriptomic vulnerability, providing an explanation as to how heterogenous pathological entities can lead to the same clinical syndrome.</p