DOES PROVIDING FREE ANTI-RETROVIRAL THERAPY ENSURE OPTIMAL ADHERENCE AMONG PEOPLE LIVING WITH HIV / AIDS?

AbstractIntroduction/Back ground: Availability of Anti-Retroviral Therapy (ART) has revolutionalised the management of Human Immunodeficiency Virus /Acquired Immuno Deficiency Syndrome (HIV/AIDS) and improved the survival of those infected with the virus. However, adherence to therapy is a prerequisite for treatment success and preventing drug resistance. Aim: The present study was carried out with the aim of determining the level of adherence and factors affecting it among patients receiving free ART. Methods: A cross sectional study design was adopted and 320 HIV positive patients receiving free ART from a district hospital in Udupi were interviewed using a semi-structured questionnaire. Adherence to ART >95% of the prescribed medication was used as the cut off for deciding on the treatment adherence. Results: An encouragingly high 96.9% of the individuals were adherent to the medication over the past month. However, 41.8% of the participants reported to have ever missed doses of ART. On univariate analysis, having ever consumed alcohol, absence of side effects such as fatigue and tingling/numbness, having a feeling of sadness and sleep disturbances, being on Efavirenz based regimen, non-disclosure HIV status, being unsure of continuing lifelong treatment were significantly associated with non-adherence (p<0.05).Conclusion: Although non adherence was of concern among a small proportion of participants, a large number of them reported to have ever missed doses of ART.  This finding suggests that adherence rate may be lower over longer periods of time. Hence, periodic assessments may address patient specific barriers and help to improve the adherence rate among this population.Â

Work related musculoskeletal disorders among medical laboratory professionals: a narrative review

Work related musculoskeletal disorders are common health problem and increasing cause of disability. Laboratory professionals are unique group of healthcare professionals who play an essential part in diagnosis and therapy planning and often their work is associated with potential health hazards. Objective of current study was to review literature on prevalence of work-related musculoskeletal disorders among medical laboratory professionals. Electronic databases and bibliographies were searched and identified papers evaluated against inclusion criteria. The searching strategy uncovered 13 reports. Total 7 studies were included for the review. A high degree of heterogeneity among studies was observed. The overall prevalence’s ranges from 40-60%. With neck being more prevalent 18-78%. However additional high quality studies are required in this area

Do interpersonal problems catalyse experimentation of substance use among adolescents?

BackgroundThe upbringing and sociocultural factors determine the initial stages of habit formation in a child. Type of family, peer company, environment at school, and surroundings tend to influence adolescent’s tendency for substance experimentation and use.AimOur aim was to identify the extent of experimental substance use and catalytic effect of interpersonal relational problems among adolescents.MethodsA self-administered health risk screening questionnaire was used. The questionnaire focused on problems related to substance use; type of substances experimented with; and interpersonal problems with parents, peers, at school, and in the neighbourhood. A cross-sectional study design was adopted (n=1770, age 16–19 years). Data obtained was entered and analysed using SPSS 15.ResultsThe proportion of experimentation with substance was found out to be more in boys as compared to girls. Alcohol was mostly consumed by them followed by cigarettes, pan masala and other substances. Interpersonal issues with mothers, fathers, at home, school and residing town were found to be significant factors that influenced adolescents for substance experimentation and use. Higher age group among adolescents sex (male) were strong socio demographic predictors of adolescent substance use.ConclusionCordial environment at home especially with parents, age, sex (male), residing town/neighbourhood were found to be very significant predictors of substance use by adolescents

What predicts mental health literacy among school teachers?

Objectives: The present study aimed at assessing high school teachers’ mental health literacy (MHL) and predictors related to study outcomes.Design: Cross-sectional studyMethods: We employed 460 high school teachers who engaged with adolescents for at least six hours per week with a minimum of five years of teaching experience in southern India. Semi-structured questionnaires were used to assess their MHL. Descriptive analysis and backward logistic regression analysis were performed. A p-value < 0.05 was set as significant.Results: Teachers’ MHL on depression was less than desirable; however, they identified 288 (62.6%) adolescents with mental health problems during their career, and 172(59.72%) were referred to mental health professionals. On logistic regression analysis, teachers’ educational status, their marital status, teaching a class with an average strength of 31-60 students per class, previous mental health training and having self-efficacy concerning seeking informationon mental health, perceived ability to spread awareness and to provide referrals were found to predict MHL among teachers.Conclusion: Sociodemographic factors including teachers’ educational status, average class strength and having had previous mental health training were predictors for MHL among high school teachers. Establishing training programs and referral networks may be key in early intervention among adolescents

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.

Prevalence of goitre and its associated factors in a coastal district of Karnataka

Context: Iodine deficiency Disorders (IDDs) are a major public health problem globally. In India more than 200 million are at risk for this disorder. It affects people of all ages and both sexes. The mental impairment caused by IDD especially in children is an important consequence of IDD. Aim: To find the prevalence of IDDs and the associated factors with it. Settings and Design: A school based cross – sectional study. Methods and Material: The study was done in Udupi district of Karnataka using a pretested, semistructured questionnaire. The villages of the three talukas (Udupi, Kundapur and Karkala) of Udupi district were sampled according to Probability Proportionate to Size (PPS).One school was chosen for the study from each of the 30 selected villages. Minimum of 90 students were selected from each school. Salt and urine samples were collected for Iodine estimation from a sub sample. Goitre was graded according to WHO/UNICEF/ICCIDD criteria. Results: A total of 3023 children were examined (M = 49.1%, F = 50.9%). The prevalence of goitre in Udupi district was 19.8%. The prevalence of goitre was found to be more amongst females compared to males (p = 0.021) and also was found to be increasing with the increasing age (p = 0.003). Of the 539 salt samples analyzed 23.7 % were inadequately iodized. Education of the father, fish consumption and occupation of the mother were found to be significant predictors of goitre. Conclusions: Goitre is a public health problem in Udupi district of Karnataka. The adequately Iodized salt coverage which should have been more than 90 % is not fulfilled. More awareness is required amongst the people about IDDs and its predictors

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.

AN IN VITRO STUDY OF CINNAMOMUM ZEYLANICUM AS NATURAL INHIBITOR OF ANGIOTENSIN-CONVERTING ENZYME (ACE) ON SHEEP (OVIS ARIES) TISSUES

Objective: The present study was aimed to find the angiotensin-converting enzyme (ACE) inhibitory activity using the methanolic extract ofCinnamomum zeylanicum (as a natural inhibitor) on sheep tissues as the enzyme source.Methods: Hippuryl-histidyl-leucine (HHL) as a substrate, tissue ACE activity was measured spectrophotometrically at 228 nm. For an incubationperiod of 30 minutes at 37°C, the linearity of ACE activity of kidney, lung, and testis enzyme was established. A known medicinal plant C. zeylanicumwas used as natural inhibitor of ACE. In this enzyme assay, inhibitory effect of methanolic extract of C. zeylanicum on kidney, lung and testicular ACEwas determined. ACE activity was confirmed by captopril, a standard inhibitor of ACE.Results: In the presence of a methanolic extract of C. zeylanicum (10:1), ACE activity was determined and this has inhibited ACE activity verysignificantly. C. zeylanicum leaves extract has reduced sheep kidney, lung, and testis ACE activity by 70.06%, 12.63%, and 20.23%, respectively.Conclusion: Significant inhibition was observed in the kidney ACE than in lung and testis ACE activity. This can propose that there may be a possiblerole in controlling blood pressure or reduction in cardiovascular diseases. Some plants with the great medicinal property may be considered aspromising sources of natural inhibitors of ACE for medicine and commercial uses. This comprehensive study may show numerous beneficial effects asa potential therapeutic agent for lowering blood pressure.Keywords: Angiotensin-converting enzyme, Natural angiotensin-converting enzyme inhibitor, Kinetic assay, Hippuryl-histidyl-leucine, Cinnamomumzeylanicum, Cardiovascular diseases

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.