A RISING THREAT – RISK FACTORS AND OUTCOMES RELATED TO INFECTIONS WITH ACINETOBACTER SPECIES

ABSTRACTObjective: Acinetobacter species is an important cause of community as well as nosocomial infections with a high mortality rate. The study was doneto analyze the risk factors associated with Acinetobacter infections and their outcomes.Methods: The clinical details of 100 patients having infections with Acinetobacter species over a period of 1-year were analyzed for underlying riskfactors and outcomes. The antibiotic sensitivity results were interpreted according to the Clinical Laboratory Standards Institute guidelines.Results: Majority of the infections caused by the Acinetobacter species were lower respiratory tract infections, most common being ventilatorassociatedpneumonia. 47% of the isolates were multi drug resistant and 26% were extensively drug resistant. There is a significant chance of drugresistance and a poor outcome with intensive care unit (ICU) stay, prolonged hospital stay of more than 7 days, the presence of 5 or more risk factors.Endotracheal intubation and mechanical ventilation were the risk factors for increased drug resistance in the ICU. Drug resistance was also seen morefrequently in patients with chronic obstructive pulmonary disease, chronic kidney disease, and patients on post-operative care.Conclusion: The steady increase in drug resistant Acinetobacter species and limited antibiotics available advocates an uncompromising approachtoward infection control and a judicious use of antibiotics especially in the ICU. An understanding about the risk factors helps in the appropriateapproach and management of the patient.Keywords: Acinetobacter, Risk factors, Invasive procedures, Nosocomial

Salivary biomarkers associated with the progression of disease in people living with HIV: A scoping review protocol [version 2; peer review: 2 approved, 1 approved with reservations, 1 not approved]

Background: Biomarkers are measurable indicators of normal biological processes, which provide an objective assessment of the physiologic state of living systems. Saliva contains several biomarkers that serve as a diagnostic tool in health and disease. Evaluation of a multitude of salivary components could potentially predict the clinical outcome. This is especially critical in a chronic, potentially life-threatening condition like human immunodeficiency virus (HIV) infection. Scrupulous evaluation of relevant biomarkers could facilitate the early detection of HIV, determine the stage of infection and monitor the disease progression. Currently, there is a paucity of validated biomarkers in saliva predicting the disease progression in people living with HIV. In this scoping review, we aim to provide an overview of the available evidence on salivary markers associated with the progression of disease in people living with HIV. Methods: The authors shall develop a tailored search strategy for each database using relevant keywords. We will search for eligible studies indexed in the following databases: MEDLINE, EMBASE, and the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and gray literature. We will restrict the search to studies published in the English language. Following deduplication, all search results will be exported to the EPPI reviewer web, where two independent reviewers using a data extraction tool developed and pretested by the review authors will screen eligible studies. The result of this review will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guidelines. Discussion: The proposed scoping review protocol will enable the identification and assessment of salivary biomarkers, which can predict disease progression in patients with HIV infection. The synthesis of evidence from this review will assist in improving our current understanding of biomarkers used to evaluate the progression of HIV infection

LIFESTYLE FACTORS AND OBESITY AMONG ADOLESCENTS IN RURAL SOUTH INDIA

Objectives: To estimate the prevalence of obesity among adolescents of thestudy area and to study the association of physical activity, dietary habitswith obesity.Methods: This was a school based cross sectional study conducted among 2963 adolescents in Udupi. They were interviewed using pre-testedquestionnaire, followed by body mass index measurement and classification using World Health Organization criteria. Statistical analysis was doneusing Mann–Whitney U-test, Kruskal–Wallis test, and Chi-square tests.Results: The prevalence of overweight was 2.4% and obesity 1.4% and they were higher among the adolescents belonging to higher socio-economicstatus, among those using motorized transport. Furthermore, 93.2% of the subjects consumed readymade food items apart from homemade ones,28.8% of them had the habit of eating in between the regular meals, and 59.6% of the subjects had the habit of consuming carbonated beveragesregularly.Conclusions: Current levels of obesity and lifestyle factors among the adolescents in the study area can significantly predispose them to the risk ofnon-communicable diseases, which needs to be considered while making policies for non-communicable diseases.Keywords: Adolescents, Obesity, Overweight, Lifestyle, Diet, World Health Organization

Attitudes toward and knowledge of collaboration of dental and medical practice among medical students in Southern India: a cross-sectional questionnaire survey [version 4; peer review: 1 approved, 2 approved with reservations]

Background: Enhancing oral health care services provided through inter-professional collaboration between medical and dental practitioner is important, and even essential. The purpose of this study is to assess the attitude toward and knowledge of medical-dental collaborative practice among medical students attending colleges in Southern India. Methods: A cross sectional questionnaire survey was conducted by inviting 900 medical students and interns of medical colleges in coastal South India with prior information and permission. The questionnaire consisted of 11 questions to assess attitude toward and knowledge of medical-dental collaborative practice and was distributed in pen & paper format to participants who agreed to take part in the study.  Chi square test was employed for data analysis. The responses obtained were correlated with age, gender and year of study of participants using Pearson’s correlation test Results: Most of the students agreed that oral health was an integral part of systemic health, however participants disagreed on attending compulsory rotation in dentistry at a statistically significant level (p<0.05), moreover participants did not agree with physicians having an active role in motivating their patients for regular dental check-up. 82% of the medical students believe that dental check-up should be included in health packages under health insurance. A statistically significant (p<0.05) difference was observed among 3 rd year & 4 th year students and interns and also it was found that female students provided more positive responses towards medical-dental collaboration. Conclusions: Even though medical students showed fairly positive attitudes and knowledge towards dentistry, the analysis within the study groups showed that knowledge and attitudes regarding the collaborative practice worsened over the academic years among the medical students

Serum calprotectin as a marker of neonatal sepsis: a hospital-based cross-sectional diagnostic study [version 1; peer review: 2 approved]

Background: Despite significant advances in neonatal care, neonatal sepsis remains a major contributor to mortality, morbidity, and protracted hospitalization. The development of early possible diagnostic indicators for newborn sepsis is critical. Since calprotectin participates in major biological processes, it could be a diagnostic marker for infection/inflammation. This study aimed to estimate serum calprotectin in neonates with clinical sepsis. In addition, we compared serum calprotectin with standard sepsis markers and serum procalcitonin to evaluate its diagnostic accuracy. Methods: A hospital-based cross-sectional diagnostic study of neonates identified with clinical sepsis using standard criteria was carried out. We compared estimated serum calprotectin levels to serum procalcitonin levels and conventional sepsis markers (leucocyte count, blood culture, immature to total neutrophil ratio, and C- reactive protein). We used SPSS version 25 to analyze the data. To examine diagnostic accuracy and determine a cut-off value for serum calprotectin, we used the receiver operating characteristics (ROC) curve. Results: Of the 83 subjects included, 36.5% (30/83) had blood culture positive status, the median value of serum calprotectin being 0.93 ng/ml (0.67 to 1.3). Respiratory, cardiovascular, and gastrointestinal instabilities were present in 67.5% (56/83), 59% (49/83), and 50.1% (42/83) cases, respectively. The presence of positive and negative blood cultures did not significantly affect sepsis parameters (p=0.09). On ROC, calprotectin was not predictive for blood culture positivity (sensitivity: 50%; specificity: 44% at 0.83 ng/ml of serum calprotectin) and C-reactive protein (CRP) levels (sensitivity: 57%; specificity: 67% at serum calprotectin levels of 0.89 ng/ml). However, compared with serum procalcitonin, serum calprotectin at 1.2 ng/ml had sensitivity and specificity of 60% and 73%, respectively.  Conclusions: Serum calprotectin did not show a distinct advantage over the existing sepsis markers. Serum calprotectin level at 1.2 ng/ml had a sensitivity and specificity of 60% and 73%, respectively, compared to serum procalcitonin in detecting neonatal sepsis

Effectiveness of multi-component modular intervention among adults with prehypertension in a village of Dakshina Kannada district - a community-based interventional study – protocol [version 2; peer review: 2 approved]

Introduction: The Joint National Committee (JNC 7) report on Prevention, Detection, Evaluation, and Treatment of Hypertension, defined "prehypertension," as individuals with a Systolic Blood Pressure (SBP) in the range of 120–139 mmHg and a (diastolic blood pressure) DBP of 80–89 mmHg. Prehypertension is directly linked with hypertension which is a precursor of CVDs. Owing to its high conversion rate to hypertension, it is important to identify individuals with blood pressures in this category and bring about lifestyle modifications in them that can prevent them from being hypertensive and from developing cardiovascular diseases later in life. Methods: This randomized controlled trial will be done among the selected pre-hypertensive adults of all genders residing in Kateel Gram panchayat, Dakshina Kannada district, Karnataka. A baseline survey will be done initially to assess the level of prehypertension among the study population. To study the effectiveness of the intervention, 142 individuals will be randomly allocated using block randomization technique to intervention and control groups. A multi-component module (educational intervention) will be developed, validated, and administered to participants in the intervention group, while the control group receives standard care. Each participant will then be followed up once in four months till the end of the study period of one year to assess for changes in SBP, DBP, WHR, BMI, stress levels, and usage of tobacco and alcohol. Ethics and dissemination: Institutional Ethics Committee approval was obtained from Kasturba Medical College in Mangalore, India.   The plans for dissemination of findings include presenting at scientific conferences and publishing in scholarly journals

KNOWLEDGE AND PRACTICE REGARDING FOOT CARE AMONG TYPE 2 DIABETES MELLITUS PATIENTS AT A TERTIARY CARE HOSPITAL IN COASTAL SOUTH INDIA

Objective: The present study was designed to assess the knowledge and practice among diabetic patients in a tertiary care hospital regarding diabeticfoot care.Methods: A cross-sectional study was conducted in government district hospital of Mangalore in the month of January 2014. A pre-designed semistructuredquestionnairewasused tocollectthe informationpertainingtotheknowledgeand practicesofthediabetic patients regardingfootcare.Thecollecteddata wereanalyzedusing Statistical PackagesforSocial Sciences version11.5.The resultsobtained wereexpressedin proportions.Results: A total of 133 subjects were assessed regarding their knowledge and practice regarding diabetic foot care. Around three-fourth (75.2%) ofparticipants had adequate knowledge. More than half (55.5%) of the subjects had adequate practice. No significant association was found betweenstudy variables such as gender, socioeconomic status, and education status with awareness regarding diabetic foot care in the present study (p&gt;0.05).Gender, socioeconomic, and educational statuses were found to be significantly associated with diabetic foot care practices.Conclusion: The gap between knowledge and practice regarding self-care among diabetic patients can be bridged by providing continuous healtheducation by the health workers. Foot care should be promoted at all available opportunities whenever the patient comes in contact with the health system.Keywords: Mangalore, Foot care, Diabetes

Gender preferences among antenatal women: a cross-sectional study from coastal South India

Background: A balanced sex ratio is essential for a stable society. Objective: The main objective of the present research was to study the perceptions of women attending the antenatal care (ANC) facility regarding their gender preferences and family composition. Method: In this cross-sectional study 132 antenatal women were interviewed in their preferred language using a predesigned semi-structured questionnaire. The collected information was analyzed using SPSS version 11.5. Results: The mean age of the study participants was 27.2 \ub1 4.1 years. The majority of the antenatal women (60.6%, n=80) did not have any gender preferences. Among those who had a gender preference (39.4%, n=52), male and female preference was reported by 55.7% (n=29) and 44.3% (n=23) of the participants respectively. The overall son preference index was observed to be 1.3. No consistent relationship could be established between the socio-demographic factors and the preference for gender. The mean preferred family size in our study was 1.85\ub10.531 and more than half of the participants had a balanced gender preference. The majority of the participants were aware that the adverse sex ratio can lead to fall in the number of brides and that it would bring about a social imbalance. Conclusion: As a developed society we need to ensure that both the genders get equal respect and are free from any sort of preferences and prejudices. To achieve this, more and more people need to be made aware of the consequences of gender imbalance and adverse sex ratio in a society

Drinking Water in an Urban Area of South India

BackgroundGlobally, 1.1 billion people lack access to improved drinking water supply and drink water that is grossly contaminated. Hence, study of water treatment assumes utmost importance in order to ensure the safety of the water consumed especially in fast developing cities. This study would provide information of drinking water management practices in the study area. We studied the sources, the treatment and storage facilities of drinking water in households and assessed the free chlorine levels in the drinking water.Method  This community based cross sectional study was conducted in Mangalore - a city of Karnataka State in South India. Using convenience sampling, 100 households were visited in the area of Boloor. Information was collected regarding demographic profile, household drinking water sources, treatment and storage practices followed by testing for free chlorine in the drinking water using O-Toluidine.ResultsStudy population had high literacy rate and 83% had their main source of drinking water from municipality, 17% had private water source. Among these 6% households had bore wells, 10% had protected dug well. Overall 99% had improved source of drinking water. Sumps were present in 32% of the households.  Of these 34.4 % cleaned it once a month. Boiling was found to be the preferred choice of water treatment; but 5% of the population (lower socio economic status) did not use any method to treat water in their households. Overall, 43% households drank water by pouring to glass from storage vessel, 34% dipped glass into vessel using hands, 23% had tap system and 84.2% of the households cleaned their storage vessel daily. O-Toluidine test showed no free chlorine in drinking water in any of the homes.ConclusionStudy population had access to improved water. However households lacked appropriate storage and handling practices of drinking water which needs to be evaluated further

Letter to the Editor

Background Disaster, whether man made or natural, may occur at any place or time. This study was conducted to assess the preparedness of hospitals in handling emergencies as per District Disaster Management Plan (DDMP) at Mangalore, a coastal city on the Western coast of Karnataka. Method A cross sectional study was conducted in 12 hospitals of Mangalore city, located at the Southwestern coast of India in April 2009, using a semi-structured proforma. All surveyed hospitals were included in the DDMP. The respondents were hospital administrators. Results Though all the hospitals surveyed were aware about the existence of DDMP in the district of Dakshina Kannada, 6 (50%) were unaware that their hospitals were included in the same plan. Out of 12 hospitals, 4 (33.3%) said that they had got a letter from DDMP, spelling out their responsibilities. Only 6 (50%) hospitals had a contingency plan for emergency. Mock drill was conducted only by 6 (50%) hospitals. Six (50%) hospitals had blood bank, 5 (41.6%) had trauma center and 8 (66.6%) had burns ward available for emergency. Half of them had more than 2 ambulances and 10(83.3%) had sufficient stock of medicines. Extra beds for emergency were available in 11(91.7%) hospitals with maximum number of 42 beds in one hospital. Conclusion; Most hospitals in Mangalore were not well prepared to manage emergencies in disasters. Facilities like burns ward, blood bank and ambulance services need to be enhanced