Association between unhygienic menstrual management practices and prevalence of lower reproductive tract infections: a hospital-based cross-sectional study in Odisha, India.

BACKGROUND: The extent to which reproductive tract infections (RTIs) are associated with poor menstrual hygiene management (MHM) practices has not been extensively studied. We aimed to determine whether poor menstrual hygiene practices were associated with three common infections of the lower reproductive tract; Bacterial vaginosis (BV), Candida, and Trichomonas vaginalis (TV). METHODS: Non-pregnant women of reproductive age (18-45 years) and attending one of two hospitals in Odisha, India, between April 2015 and February 2016 were recruited for the study. A standardized questionnaire was used to collect information on: MHM practices, clinical symptoms for the three infections, and socio-economic and demographic information. Specimens from posterior vaginal fornix were collected using swabs for diagnosis of BV, Candida and TV infection. RESULTS: A total of 558 women were recruited for the study of whom 62.4% were diagnosed with at least one of the three tested infections and 52% presented with one or more RTI symptoms. BV was the most prevalent infection (41%), followed by Candida infection (34%) and TV infection (5.6%). After adjustment for potentially confounding factors, women diagnosed with Candida infection were more likely to use reusable absorbent material (aPRR = 1.54, 95%CI 1.2-2.0) and practice lower frequency of personal washing (aPRR = 1.34, 95%CI 1.07-1.7). Women with BV were more likely to practice personal washing less frequently (aPRR = 1.25, 95%CI 1.0-1.5), change absorbent material outside a toilet facility (aPRR = 1.21, 95%CI 1.0-1.48) whilst a higher frequency of absorbent material changing was protective (aPRR = 0.56, 95%CI 0.4-0.75). No studied factors were found to be associated with TV infection. In addition, among women reusing absorbent material, Candida but not BV or TV - infection was more frequent who dried their pads inside their houses and who stored the cloth hidden in the toilet compartment. CONCLUSION: The results of our study add to growing number of studies which demonstrate a strong and consistent association between poor menstrual hygiene practices and higher prevalence of lower RTIs

Role of H- and D- MATE-Type Transporters from Multidrug Resistant Clinical Isolates of Vibrio fluvialis in Conferring Fluoroquinolone Resistance

Background: The study seeks to understand the role of efflux pumps in multidrug resistance displayed by the clinical isolates of Vibrio fluvialis, a pathogen known to cause cholera-like diarrhoea. Methodology: Two putative MATE family efflux pumps (H- and D-type) were PCR amplified from clinical isolates of V. fluvialis obtained from Kolkata, India, in 2006 and sequenced. Bioinformatic analysis of these proteins was done to predict protein structures. Subsequently, the genes were cloned and expressed in a drug hypersusceptible Escherichia coli strain KAM32 using the vector pBR322. The recombinant clones were tested for the functionality of the efflux pump proteins by MIC determination and drug transport assays using fluorimeter. Results: The sequences of the genes were found to be around 99 % identical to their counterparts in V. cholerae. Protein structure predicting servers TMHMM and I-TASSER depicted ten-twelve membrane helical structures for both type of pumps. Real time PCR showed that these genes were expressed in the native V. fluvialis isolates. In the drug transport assays, the V. fluvialis clinical isolates as well as recombinant E. coli harbouring the efflux pump genes showed the energydependent and sodium ion-dependent drug transport activity. KAM32 cells harbouring the recombinant plasmids showed elevated MIC to the fluoroquinolones, norfloxacin and ciprofloxacin but H-type pumps VCH and VFH from V. cholerae and V. fluvialis respectively, showed decreased MIC to aminoglycosides like gentamicin, kanamycin and streptomycin. Decrease i

Effect of examination stress on blood sugar in medical students

Background: It has been proved by different research works that examination is a stress factor for students. Medical curriculum is as such stressful for students. Thus, in this study, researchers proposed to observe the changes in blood sugar level owing to examination stress in medical students. Materials and Methods: A general questionnaire was distributed among 1st year MBBS students for selection of subjects. The questionnaire included demographic data, history of diseases, history of drug abuse, and family history of diseases. After the return of questionnaires, 49 1st year MBBS students were selected for this study. Baseline data of heart rate (HR), blood pressure (BP), and fasting blood sugar (FBS) were observed 1 month before beginning of the first professional examination. Then, the second setting of the same data as baseline was observed on the day of practical and viva examination. Data analysis was done by paired t-test to find out the effect of examination on different parameters. P< 0.05 was considered to be significant. Results: Examination stress was responsible to raise HR, systolic and diastolic BP, and FBS from baseline significantly at P< 0.001. Conclusion: As shown in results, the effect of examination raises HR and BP from baseline, confirming that examination creates some stress on students. Thus, it was assumed that examination stress is responsible to raise blood sugar level that is essential to supply extra energy to vital organs

Minimum inhibitory concentrations (MICs) for recombinant clones carrying MATE-type efflux pump genes from <i>V. fluvialis</i> and <i>V. cholerae</i>.

<p>VCH and VCD : pBR322 recombinant clones carrying H- and D- MATE pump genes from <i>V. cholerae</i> N16961.</p><p>VFH and VFD : pBR322 recombinant clones carrying H- and D- MATE pump genes from a clinical isolate of <i>V. fluvialis</i>.</p

2D and 3D structure predictions of H- and D- type MATE pumps.

<p><b>A and C.</b> Schematic representation of the predicted secondary structure of VFD and VFH respectively. The topology was predicted based on the algorithm TMHMM Server 2.0. <b>B and D.</b> Schematic representation of the predicted 3D structure of VFD and VFH respectively. The topology was predicted based on the algorithm I-TASSER.</p

Sodium-ion dependence of recombinant efflux pumps

<p>Induction of norfloxacin efflux in the presence of 100 mM sodium chloride (+NaCl) or 100 mM potassium chloride (+KCl) in the <i>E. coli</i> KAM32 cells transformed with <b>A.. </b><i>pBR322</i> or <b>B.. </b><i>pBR322-vfh</i>. <b>C.</b> Effect of increase in Sodium ion concentration on the efflux pump activity of VFH. *, The activity of VFH in the presence of 100 mM and 200 mM NaCl was significantly different from that of the control without NaCl (<i>P</i><0.05).</p

Higher vaginal pH in Trichomonas vaginalis infection with intermediate Nugent score in reproductive-age women-a hospital-based cross-sectional study in Odisha, India.

A close association between Trichomonas vaginalis (TV) infection and bacterial vaginosis (BV) has been reported. Some other studies have found association is stronger with intermediate Nugent score than BV. Most studies have used wet mount microscopy, a relatively insensitive method, to detect TV infection. We wanted to study the association of TV infection with BV and with intermediate Nugent score. We undertook a cross-sectional hospital-based study of 1110 non-pregnant women from Odisha state, India, aged between 18 and 45 years, collecting vaginal swabs for diagnosis of BV by Nugent score (NS) criteria and TV by PCR analysis. TV infection was found in 13.3% of women with intermediate Nugent score (NS 4-6) and 13.6% with BV (NS 7-10). Before adjustment, TV infection was associated with BV, intermediate Nugent, vaginal pH ≥ 4.5, and age group between 26 and 35 years. Multivariate analysis confirmed that TV infection was more likely to have raised vaginal pH, either BV or intermediate Nugent. Proportion of TV cases increased sequentially with the increase in Nugent score up to NS 6, after which a decline was observed. Vaginal pH was higher in the TV-infected group than the uninfected group in women with intermediate Nugent, but no difference was noticed in women with BV. TV infection was equally prevalent in women with intermediate Nugent as well as BV. In the intermediate Nugent group women, TV infection was found only when vaginal pH was raised, indicating a crucial role of vaginal pH in determining TV infection