NOSOCOMIAL INFECTION BY NON-FERMENTING GRAM NEGATIVE BACILLI IN TERTIARY CARE HOSPITAL: SCREENING AND CURE

Objective: The purpose of the present study was to identify the Non-Fermenting Gram Negative Bacteria from the tertiary care hospital.Methods: The conventional method was used i.e. Antibiotic susceptibility test which was performed by Kirby–Bauer disc diffusion method and analysis of microbes was done by Vitek-2.Results: 172 samples were identified as Non-Fermenting Gram-Negative Bacilli from 1526 respiratory samples. Acinetobacter baumanii was the predominant isolate accounting 103 (59.88%) specimens followed by Pseudomonas aeruginosa 33.13%. Other isolates were Stenotrophomonas maltophilia 5.23% and Burkholderi acepacia1.74%. From the 172 samples, Endotracheal Aspirate was found to be the most infected amongst all the other samples. Acinetobacter baumanii and Pseudomonas aeruginosa were the most common NFGNB isolated in our study from patients of Respiratory Tract Infections.Conclusion: Both Acinetobacter baumanii and Pseudomonas aeruginosa showed good sensitivity to colistin, amikacin, cefoperazone while in most cases carbapenam is found to be highly resistant. Colistin along with amikacin and cefoperazone should be used against this pathogen for treatment.Keywords: Nosocomial infection, Gram negative bacilli, Tertiary care hospital, Lower respiratory tract infection, Non-fermenting bacill

The Stress of COVID-19: Playing Havoc with the Hormones-A Review

Severe acute respiratory syndrome coronavirus- 2 (SARS-CoV-2) has affected millions of people across the world engendering an unprecedented pandemic. Coronavirus disease (COVID)-19 can present asymptomatic or in the form of the acute respiratory syndrome, viral pneumonia,or sepsis. Due to the novelty of the disease, the endocrine manifestations are not fully understood. It becomes indispensable to address the underlying endocrine disruptions contributing to the severe form of illness and thereby increasing the mortality.We discuss here the SARS-CoV-2 virus and endocrine reverberations based on the research with structurally similar SARS-COV-1. SARS-CoV-2 enters the body via its attachment to the angiotensin-converting enzyme 2 (ACE2) receptors. Apart from lungs,ACE2 expression on various organs can lead to endocrine perturbations.In COVID-19 infection, pre-existing endocrine disorders warrant cautious management and may require replacement therapy. COVID-19 and its repercussions on hormones are discussed extensively in this review

Community based cross sectional study: to assess the prevalence of arthritic symptoms in an army garrison in large city of North India

Background: Arthritis affects almost 350 million people globally and is one of the leading causes of disability in the world. The prevalence in India is like that in developed countries. Symptoms of arthritis have been found to be influenced by alcohol intake, smoking, obesity and type of diet which lead to aggravation in pain, exacerbation in disease activity and deterioration in general health.Methods: Present community-based cross-sectional study was conducted in a large military station in North India over a period of one month. Armed Forces personnel and their family members aged 18 yrs and above residing in military station and consenting to the study were included. A sample of 1475 was studied.Results: The age of participants ranged from 18 to 70 yrs (median 32±7.4 yrs) with 20.54% females and 79.46% males. The prevalence of symptoms suggestive of Gout, RA, OA and Spondyloarthritis was 8.95% (95% CI, 7.54, 10.52), 3.25% (2.41, 4.29), 11.32% (9.75, 13.05) and 14.17% (12.43, 16.05), respectively. Symptoms suggestive of RA were found to be significantly associated with female gender, those of Gout and Spondyloarthritis with male gender, while OA did not have any gender predisposition.Conclusions: The population with symptoms of arthritis needs to be identified early by early symptomatic diagnosis and measures instituted for appropriate management to prevent future complications and associated morbidity

An Insight into Green Practices followed in the Indian Hotel industry.

The study measures the consumer’s attitude and behavioral practices relating to the use of green practice in the Indian hotel industry. The methodology employed was quantitative and use was made of a structured questionnaire followed by secondary research. Convenience sampling was utilized. The study was conducted in Delhi and Delhi NCR. Factor analysis and correlation was used to measure the consumers’ attitudes and behaviors. Consumers availing themselves of hotel services are very particular about the environmental practices followed by their chosen property. They tend to stay in hotels which have adopted green practices in their operations but are also concerned about the service quality that is offered. Consumers were found to be unwilling to pay extra for green practices to be adopted. The hotel industry will be required to make an investment in green practices which are considered to be environmental friendly. The government should acknowledge these practices and motivate the hotels by offering them incentives or benefits such as for example, tax deductions. The study measured consumer behaviour towards green practice availability. The hotel industry is required to follow a business model that must of necessity be in line with the goal of sustainable development so that hotels can sustain themselves in the long run. They are required and urged to employ green practices as their preferred working model

Kawasaki disease and the environment: an enigmatic interplay

Kawasaki disease (KD) is a common systemic vasculitis of childhood. Although it has been almost 6 decades since Dr. Tomisaku Kawasaki reported the first case series of KD, the underlying cause remains a mystery. KD is a self-limiting disease. However, a dreaded complication is development of coronary artery abnormalities (CAAs). KD is the most common cause of acquired heart disease in children in the developed world and is being increasingly reported from developing countries too. Over the years, significant observations have been made about epidemiology of KD. It usually affects children below 5, has male preponderance and has significantly higher incidence in North East Asian countries. While several hypotheses have been proffered for etiology of KD, none have been conclusive. These include associations of KD epidemics in Japan and the United Stated with changes in tropospheric wind patterns suggesting wind-borne agents, global studies showing peaks of incidence related to season, and increased rates in populations with a higher socioeconomic profile related to hygiene hypothesis and vaccination. Furthermore, the self-limiting, febrile nature of KD suggests an infectious etiology, more so with sudden decline noted in cases in Japan with onset of COVID-19 mitigation measures. Finally, single nucleotide polymorphisms have been identified as possible risk alleles in patients with KD and their significance in the pathogenesis of this disease are also being defined. The purpose of this review is to elucidate the puzzling associations of KD with different environmental factors. Looking at patterns associated with KD may help us better predict and understand this disease

Mapping of variations in child stunting, wasting and underweight within the states of India: the Global Burden of Disease Study 2000–2017

Background To inform actions at the district level under the National Nutrition Mission (NNM), we assessed the prevalence trends of child growth failure (CGF) indicators for all districts in India and inequality between districts within the states. Methods We assessed the trends of CGF indicators (stunting, wasting and underweight) from 2000 to 2017 across the districts of India, aggregated from 5 × 5 km grid estimates, using all accessible data from various surveys with subnational geographical information. The states were categorised into three groups using their Socio-demographic Index (SDI) levels calculated as part of the Global Burden of Disease Study based on per capita income, mean education and fertility rate in women younger than 25 years. Inequality between districts within the states was assessed using coefficient of variation (CV). We projected the prevalence of CGF indicators for the districts up to 2030 based on the trends from 2000 to 2017 to compare with the NNM 2022 targets for stunting and underweight, and the WHO/UNICEF 2030 targets for stunting and wasting. We assessed Pearson correlation coefficient between two major national surveys for district-level estimates of CGF indicators in the states. Findings The prevalence of stunting ranged 3.8-fold from 16.4% (95% UI 15.2–17.8) to 62.8% (95% UI 61.5–64.0) among the 723 districts of India in 2017, wasting ranged 5.4-fold from 5.5% (95% UI 5.1–6.1) to 30.0% (95% UI 28.2–31.8), and underweight ranged 4.6-fold from 11.0% (95% UI 10.5–11.9) to 51.0% (95% UI 49.9–52.1). 36.1% of the districts in India had stunting prevalence 40% or more, with 67.0% districts in the low SDI states group and only 1.1% districts in the high SDI states with this level of stunting. The prevalence of stunting declined significantly from 2010 to 2017 in 98.5% of the districts with a maximum decline of 41.2% (95% UI 40.3–42.5), wasting in 61.3% with a maximum decline of 44.0% (95% UI 42.3–46.7), and underweight in 95.0% with a maximum decline of 53.9% (95% UI 52.8–55.4). The CV varied 7.4-fold for stunting, 12.2-fold for wasting, and 8.6-fold for underweight between the states in 2017; the CV increased for stunting in 28 out of 31 states, for wasting in 16 states, and for underweight in 20 states from 2000 to 2017. In order to reach the NNM 2022 targets for stunting and underweight individually, 82.6% and 98.5% of the districts in India would need a rate of improvement higher than they had up to 2017, respectively. To achieve the WHO/UNICEF 2030 target for wasting, all districts in India would need a rate of improvement higher than they had up to 2017. The correlation between the two national surveys for district-level estimates was poor, with Pearson correlation coefficient of 0.7 only in Odisha and four small north-eastern states out of the 27 states covered by these surveys. Interpretation CGF indicators have improved in India, but there are substantial variations between the districts in their magnitude and rate of decline, and the inequality between districts has increased in a large proportion of the states. The poor correlation between the national surveys for CGF estimates highlights the need to standardise collection of anthropometric data in India. The district-level trends in this report provide a useful reference for targeting the efforts under NNM to reduce CGF across India and meet the Indian and global targets. Keywords Child growth failureDistrict-levelGeospatial mappingInequalityNational Nutrition MissionPrevalenceStuntingTime trendsUnder-fiveUndernutritionUnderweightWastingWHO/UNICEF target

Cylindrical energy analyzer for heavy ion bbeam diagnostics

O estudo de fenómenos de transporte e turbulência em plasmas é fundamental para a compreensão e controle do confinamento de partículas e energia em máquinas de fusão nuclear do tipo ‘Tokamak’ ou ‘Stellarator’. O diagnóstico de feixe de iões pesados (DFIP) é uma ferramenta única que pode medir localmente várias quantidades de grande interesse tais como a densidade do plasma (ne), o potencial do plasma (Phi), a temperatura electrónica (Te) e o campo magnético poloidal (Bp), ao longo de todo o raio do plasma com uma resolução espacial de alguns mm e até aos microsegundos de resolução temporal (centenas de kHz). O objectivo da tese é o de desenvolver um Analizador Electroestático Cilíndrico de 90o (AEC-90o) e demonstrar a sua capacidade para medir o potencial do plasma com uma resolução de energia aceitável (poucas dezenas de Volt). A geometria partícular deste analisador electroestático foi escolhida por forma a permitir as medidas do potencial de plasma em paralelo com as medidas da densidade do plasma e campo magnético poloidal obtidos com o DFIP sem necessitar de se alterar a trajectoria do feixe sonda durante a descarga de plasma. O traballho apresentado versa a conceção, desenho e simulação (utilizando o código SIMION) de um analizador multi-canal do tipo AEC-90o. A operação é baseada num modo inovador de desaceleração tirando partido do retardamento e focagem do feixe de prova por um campo electroestático apropriado aplicado à entrada do analisador. A operação no modo de desaceleração demonstrou vantagens significativas na resolução das medidas da energia do feixe e nas caraterísticas de aberração angular quando comparado com o modo convencional de operação do AEC-90o. As previsões obtidas pela simulação foram verificadas experimentalmente por meio de um protótipo AEC-90o com ½ das dimensões lineares usando um feixe de electrões numa montagem dedicada a este fim. Uma unidade intermédia adicional, denominada modulo de entrada electroestático (MEE), responsável pela defleção e focagem dos feixes secundários provenientes do plasma até à entrada do AEC-90o, foi igualmente desenhada e otimizada no programa SIMION. A montagem combinada do MEE e do protótipo ½ AEC-90o foi instalada e comissionada no tokamak ISTTOK (Portugal) onde foram obtidas com sucesso as medidas do potencial no centro do plasma. O analizador foi calibrado usando um método indireto com o fim de determinar o valor absoluto do potencial do plasma. A segunda parte desta tese compreende as expriências coduzidas pela autora na dupla Sonda de Feixe de Iões Pesados (SFIP) no ‘Stellarator’TJ-II na CIEMAT (Espanha). O trabalho desnvolvido no TJ-II demonstra a importância das medidas do perfil de potencial e densidade afim de melhor compreender o comportamento do plasma. As experiências foram desenvolvidas em torno de três objectivos: (i) Os perfis centrais do potencial do plasma foram investigados durante a polarização da periferia do plasma com o fim de identificar assimetrias, medindo com duas sondas SFIP separadas toroidalmente; (ii) Medições utilizando o SFIP de linhas de nível 2D do potencial de plasma e densidade e das suas flutuações num regime novo de rastreamento de energia, em plasmas de baixa densidade sustentados por ‘ECRH’; (iii) Medidas do perfil do potencial do plasma quando sujeito a aquecimento por feixes de neutros (FN) injectados em contra e em paralelo à corrente de plasma e sua comparação afim de investigar a correlação entre confinamento de partículas e injeção de feies de neutros com as predições teoricas.The study of plasma turbulence and transport is crucial to understand and control the particle and energy confinement in fusion devices such as tokamak or stellarators. The Heavy Ion Beam Diagnostic (HIBD) is a unique tool that can provide the local measurement of the quantities of interest such as plasma density (ne), the plasma potential (Phi), the electron temperature (Te) and the poloidal magnetic field (Bp), along a radial scan in the plasma with a spatial resolution of several mm and down to the microsecond range temporal resolution (hundreds of kHz). The aim of the thesis is to develop a high resolution 90º cylindrical energy analyzer (CEA) and demonstrate its capability to measure plasma potential with sufficient energy resolution (in the order of tens of Volt). The particular analyzer geometry is chosen to provide the plasma potential measurements along with the profiles of plasma density and poloidal magnetic field obtained by the HIBD without the need to scan the probing beam during the plasma discharge. The present work covers the conceptualization, design and simulation (using SIMION code) of a multiple channel 90º CEA. The operation is based in an innovative deceleration mode which takes advantage of the beam retardation and focusing property of a customized electrostatic field at the input of the analyzer. The deceleration mode has demonstrated significant improvements in the beam energy measurements resolution and angle aberration characteristics as compared to conventional CEA operation. The simulation predictions were verified by experimental results obtained by testing a half-size 90º CEA prototype with an electron beam installed in a dedicated test facility. An additional intermediate unit, named electrostatic input module (EIM), responsible to focus and deflect the secondary beams from plasma output to CEA input, was also designed and optimized in SIMION. The combined set-up of EIM and half-size 90º CEA prototype was installed and commissioned in ISTTOK tokamak (Portugal) to successfully obtain the measurements of plasma potential from the core. The analyzer has been calibrated using an ‘indirect calibration’ approach in order to determine the absolute plasma potential. The second part of this thesis work covers the experiments performed by the author on the dual heavy ion beam probe (HIBP) at TJ-II stellarator at CIEMAT (Spain). The work at TJ-II investigates and demonstrates the significance of potential and density profile measurement to understand the behavior of the plasma. The experiments were developed around three experimental objectives: (i) The plasma core potential profiles were investigated during external plasma edge biasing in order to probe asymmetries by observing the plasma potential response measured by two toroidally separated HIBP’s; (ii) 2D poloidal contour plots of plasma potential and density and their fluctuations have been measured by HIBP in a new energy scanning mode in low density plasmas sustained by ECRH; (iii) The plasma potential profiles for plasmas heated by counter- and co- neutral beam current drive injection (NBI) are obtained and compared in order to correlate the fast particle confinement with NBI current drive injection as predicted theoretically.I would like to acknowledge that this work was supported by the European Commission in the framework of the Erasmus Mundus International Doctoral College in Fusion Science and Engineering (FUSION-DC). I would also like to acknowledge Fundação para a Ciência e a Tecnologia (FCT) and EuroFusion for the funding for latter part of this thesis work.Programa de Doctorado en Plasmas y Fusión Nuclear por la Universidad Carlos III de MadridVocal: Bernardo Brotas Carvalho.- Vocal: Luis García Gonzalo.- Vocal: Martin Hron.- Vocal: Marek Scholz.- Vocal: Hartmut Zoh