Characterisation of Nonfermenting Gram Negative Bacilli in Clinical Specimens and Molecular Typing of Drug Resistance.

INTRODUCTION : Nonfermentative Gram negative bacilli (NFGNB) are a group of aerobic, non Spore forming organisms that either do not use carbohydrates as a source of energy or Degrade them through metabolic pathways other than fermentation. These bacteria are ubiquitous in nature particularly in soil and water. Although frequently considered as contaminants, most of the nonfermenting gram negative bacilli have emerged as important nosocomial pathogens causing opportunistic infections in Immmunocompromised hosts. Humidifiers, ventilator machines, dialysate fluids and catheter devices in the hospital environment have provided opportunities for these organisms to establish infection. Non-fermenting Gram negative bacilli cause variety of infections including Urinary tract infections, wound infections, septicemia, pneumonia, osteomyelitis, Meningitis etc. They are being recovered with increasing frequency from clinical specimens. Chronic infection, longer duration of hospitalization and prolonged antibiotic therapy are the predisposing factors for infection with nonfermenters. This group includes organisms from diverse genera like Pseudomonas, Acinetobacter, Stenotrophomonas, Burkholderia, Alcaligenes, Weeksella etc, with Pseudomonas Aeruginosa being the predominant species recovered from clinical specimens. The present study was therefore undertaken to identify the nonfermenters from various clinical specimens, to analyse the risk factors associated with their infections, to Determine the multidrug resistance and to guide initial empiric therapy for infections caused by them. AIMS AND OBJECTIVES : To isolate and speciate the nonfermenters from various clinical specimens. To study the sensitivity patterns of the isolates with common antimicrobials. To detect the incidence of multidrug resistance among nonfermenters. To detect the production of extended spectrum of betalactamases. To detect the acquired resistance to carbapenam antibiotics and production of acquired metallobetalactamases (MBL). To identify the genes responsible for acquired MBL production. To formulate antibiotic therapy for the infections caused by nonfermenters. MATERIALS & METHODS : All statistical analyses were carried out using SPSS for Windows. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. P values were calculated using the chi-square test. A P value of < 0.05 was considered significant. A total of 156 nonfermenting bacteria isolated from various clinical specimens like pus, urine, blood, bronchoalveolar lavage, endotracheal aspirations, drain tip and cerebrospinal fluids collected from both outpatients and inpatients of Government General Hospital, Chennai were studied. CONCLUSION : Observations from the present study showed the aerobic NFGNB which are usually considered as contaminants are now emerging as important nosocomial pathogens. The various clinical specimens from which they were isolated proved their existence in all sites leading to a range of diseases. Different sensitivity pattern and multidrug resistance exhibited by nonfermenters pose a great problem in treating these infections. ESBL and MBL production by these organisms lead to high morbidity and mortality as we are left with the only option of treating them by potentially toxic agents like Colistin and Polymyxin B. Awareness of their entry into a hospital environment is the first step that clinical microbiologists can take to address this problem. Care in detection, evaluation of effective antibiotic options, judicious use of antibiotics by instituting antibiotic policy of combination therapy and rigorous infection control measures will help to fight against these multidrug resistant nonfermenters in the effective management of patients

A clinical study on Pitha Perumbadu (Menorrhagia) with evaluation of siddha drug Naaval Nei

The clinical study on PITHA PERUMBADU ROGAM was carried out in Post graduate department of Maruthuvam, Government Siddha Medical College, Aringar Anna Government Hospital, Chennai – 106 during the period of 2015 - 2017. A total of 20 patients were treated in the Outpatient department. The clinical and pathological assessment was carried out on the basis of Siddha and Modern aspects. All the patients were treated with NAAVAL NEI (5 gm TDS). The duration of the treatment was fixed as ONE MANDALAM (48 DAYS). The comparatively larger incidence of Pitha perumbadu was found to be in 15-25 years of age. The prevalence of the disease was high among Middle class populations 45% followed by Lower class 30% and High class population 25%. Out of 20 patients, 2 patient (10%) were a student, 6 patients (30%) were working women, 12 patients (60%) were house wife. In case of diet, 70% patients consume Mixed diet. From selected 20 patients, 5 patients (25%) comes under Kaarkaalam, 3 patients (15%) comes under Munpani, 2 patients (10%) comes under Elavenil, 2 patients (10%) comes under Mudhuvenil kaalam and 8 patients (40%) comes under Pinpanikaalam. Out of 20 patients, 80% comes under Neithal category. In mukkutram aspect - In Vatham: Abanan (100%), Praanan (20%), Viyanan (100%), Udhanan (15%), Koorman (15%), Samanan (60%), and Devathathan (100%) were affected. In Pitham: Sathagam (100%), Ranjagam (80%), Alosagam (15%), Praasagam (20%) and Analagam (60%) were affected. In Kabham: Avalambagam (20%), Kilethagam (60%), Tharpgam (30%), Santhigam (40%) were affected. Among Ezhu Udal Thathukkal, Saaram (100%), Senneer (80%), Enbu (40%), Suronitham (100%) were affected. Among Envagai Thervugal Naa (10%), Niram (10%), Vizhi (10%), Malam (40%) Moothiram (10%) and Naadi (100%) were affected. Naadi showed Pitha vatha naadi (65%) and Vatha pitha naadi (35%). In neikuri examination Pitha neer (65%) and vatha neer (35%) were seen. The ingredients of trial medicines were found to have the properties of reducing the symptoms of PITHA PERUMBADU ROGAM. In Naaval Nei, basic radicals like iron, calcium and reducing sugar were present. The Toxicological studies of the trial medicine reveals no toxicity. The Pharmacological studies of the trial medicine shows styptic activity. The Bio statistical report of the clinical trial shows significant P value and thus concluded that, the treatment is effective and significant. Among 20 patients, 65% of cases showed good result and 25% of cases showed moderate result and 10% of cases showed fair result in PITHA PERUMBADU ROGAM (MENORRHAGIA). CONCLUSION: Pitha Perumbadu is primarily due to the derangement of Pitha kutram. The ingredients of the medicine Naaval nei have the properties of neutralizing the deranged kutram. From the preclinical toxicity studies, the medicine Naaval nei revealed no toxicity and proved to be safe. From the preclinical pharmacological studies, it is evident that the medicine Naaval nei have Styptic activity. No adverse effects was reported during the course of the treatment. The medicine Naaval nei which gives a maximum relief from the considerable symptoms of Menorrhagia such as excessive menstruation, prolonged menstruation, presence of blood clots, lower abdominal pain and low back ache. The ingredients of the trial drug is easily available. The trial medicine is economical and palatable. Therefore I conclude that, the medicine Naaval nei can give a better solution for Pitha Perumbadu

A study on prevalence of alcohol consumption among higher secondary school students in Theni district, Tamil Nadu

Background: Studies show that in India, the health loss from alcohol will grow larger, unless effective interventions are implemented. Initiation of alcohol intake starts from a very early age and is higher in rural areas. The best way to reduce alcoholism is prevention rather than curing the already addicted persons. For this we need to know the magnitude of this problem. This study is aimed at estimating the prevalence, identifying the causative and contributing factors of alcoholism among higher secondary school children of Theni district.Methods: A self-administered validated questionnaire was given to the male school students of 15 to 17 years (XI and XII students) to assess the prevalence and pattern of alcohol use among them. The questionnaire was prepared with reference from the global school-based student health survey (GSHS), the alcohol use disorders identification test (AUDIT) questionnaire and the cut-annoyed-guilty- eye (CAGE) questionnaire. Data analysis was done using software OpenEpi, Version 3.Results: A total of 500 students were analyzed with a response rate of 94% (n=470). The overall prevalence of alcohol use was found to be 31.06%. Nearly 70% had the possibility of alcoholism and should be investigated further for severity of alcohol use, 30% had impaired control over drinking almost daily and 17% had injury or injured someone because of drinking.Conclusions: The mean age of initiation of alcohol consumption is decreasing and the number of alcohol consumers is increasing

Pattern of adverse effects in patients with nephrotic syndrome on oral prednisolone

Background: Nephrotic syndrome is a common illness affecting the paediatric age group and 80% of the idiopathic syndrome is steroid sensitive. Multiple relapses make them vulnerable to the adverse effects of corticosteroids. There is limited literature evidence for the adverse effects of steroids in children with renal pathology.Methods: This descriptive, cross sectional study analyses the adverse effects of oral prednisolone in children and adults with nephrotic syndrome Fifty-five patients with nephrotic syndrome, attending nephrology or paediatric OP, more than 3 years of age and who were on oral prednisolone for a minimum of eight weeks were included in the study. Demographic details, detailed history, lab investigations and ophthalmic examination were done and the results were analysed.Results: Hypertension and behavioural changes were the most common adverse effects followed by dermatological, endocrine and metabolic changes. Infections and gastrointestinal disturbances were more in adults (p <0.05). Short stature was more in children (p< 0.05). There was no abnormality in blood glucose levels and body weight. Hypertension, cushingoid habitus, infections and short stature were statistically less in patients on alternate day prednisolone. But no statistical association could be made between the occurrence of cataract and the pattern of prednisolone use.Conclusions: Adverse effects pattern is different among adults and children. Also, the adverse effects are less with alternate day prednisolone regimen. Long term follow up into their adulthood is needed to analyse the morbidity produced by corticosteroids in these subsets of population

An Unusual Presentation of “Two-Thirds Tumor” in the Mandible – A Diagnostic Quandary with a Review of the Literature

An adenomatoid odontogenic tumor (AOT) is an uncommon benign tumor of the oral cavity commonly found in the maxillary anterior region and is associated with impacted canines in young females. It rarely occurs in the mandibular region with no impacted or missing teeth. A 21-year-old female reported to the clinic with swelling on the right side of the face for the past six months with no history of pain. Radiographic features such as unilocular radiolucency with thinning of the cortical borders and considerable buccal cortical expansion, as well as some evidence of radiopaque specks were noted. Histopathological examination revealed cells with hyperchromatic nuclei, rosette-like structures with focal areas of calcified mass, and concentric rings resembling Liesegang rings, suggestive of AOT. The tumor was treated surgically by enucleation and cauterization. Although follicular type is a common variant, the tumor presented in this case was of extrafollicular type noted in the mandibular canine and premolar regions of a young female patient with no related impacted tooth

On Solving Multi-Attribute Decision Making Problem Using AHP

Multi-attribute Decision Making (MADM) is concerned with the elucidation of the levels of preference of decision alternatives, through judgments made over a number of criteria. Many complex MADM problems are characterized with both quantitative and qualitative-of preference of decision alternatives, through judgments made over a number of criteria. Many complex MADM problems are characterized with both quantitative and qualitative-attributes. In selection of its suppliers, an organization needs to take into account such attributes as quality, technical capability, supply chain management, financial soundness, environmental and so on. Many smart technologies are used in modern cities to improve society's well-being in many ways. The proposed research focuses on communication methods for data applications. Our main goal for this paper is to use little energy as possible while delivering as much data as possible by using multi-attribute decision-making

Efficacy of Kumkum as a Surrogate for Eosin in Routine Histological Sections: An Observational Study

Introduction: Stains are a crucial component of laboratory procedure. They help in highlighting the different tissues, both normal and abnormal, which plays an important role in diagnostic histopathology. Synthetic dyes are utilised for majority of the stains in histology. Among the natural surrogates studied, Kumkum is less researched. Aim: To compare the staining characteristics of Kumkum, which imparts red colour as an alternative to eosin. Materials and Methods: This observational study was conducted at Histopathology section, Pathology department at Chettinad Hospital and Research Institute for a period of six months from January 2022 to June 2022. In 50 tissue blocks, each was made into two sections and one was stained with routine Haematoxylin and Eosin (H&E), while the other was stained with Haematoxylin and Kumkum solution (H&K). The Cellular Architecture (CA) (based on distinct or indistinct nucleus, cytoplasm) and quality of staining (poor, satisfactory or good) of H&E and H&K solution was compared and a scoring system was given. The scores were analysed with Chi-square test using SPSS software (version 25). Results: Out of 100 slides, 45 (90%) stained with H&E and 48 (96%) with H&K showed distinct CA. A total of 47 slides (94%) stained with H&K and 41 (82%) with H&E showed good quality of staining. Conclusion: Kumkum solution appears to be an efficient counterstain in place of eosin in highlighting the normal structures in histopathological sections. It highlighted the RBCs in the arteries and cytoplasm of the cells in glandular and squamous epithelium better than or equally good as eosin

Correlation of chronological age with dental age estimated using modified Cameriere’s method and UT-age estimation software — a cross-sectional study

Abstract Background Estimating age is essential in both the analysis of human skeletal remains and assessing live persons. The third molar develops over a longer period and is hence used in age estimation for subadults. Since dental age correlates with chronological age better than other growth markers, this study aims to assess the reliability of dental age assessed using the University of Texas (UT) age estimation method and modified Cameriere’s method. Methods It is a retrospective cross-sectional study in which the development and maturation of mandibular third molars were examined in 600 orthopantomograms (264 males and 336 females) of South Indian individuals (16–23 years). Dental age was estimated by using an Indian-specific formula based on maturity index value and the UT-age estimation  software program. The results were evaluated using the Student’s t-test for both methods and Pearson’s correlation test to compare chronological age with estimated dental age. Results Positive correlation was noted between chronological age and estimated dental age for males, females, and the total sample with highly statistically significant differences (p = 0.000). Modified Cameriere’s method underestimated dental age in samples ranging from less than 1 year to more than 2 years. UT-age estimation method underestimated age in samples above 20 years and overestimated age in samples below 20 years. The predictive classification of utilizing the maturity index was 79.17% accurate. Conclusions Dental age was negligibly over and underestimated in UT software method whereas it was overestimated in the modified Cameriere's method. To evaluate the reliability of these two methods, studies with larger sample sizes and population-specific data sets should be performed. Graphical Abstrac

Knowledge, attitude, and perception of dentists regarding the role of Artificial Intelligence and its applications in Oral Medicine and Radiology: a cross sectional study

Background and objective: There is a paradigm shift in the medical and dental fields due to the introduction of artificial intelligence (AI). Since AI has a potential impact on current and future practitioners, understanding the basic concept, working principle, and likely applications of AI as a diagnostic tool in Oral Medicine and Radiology is necessary for its widespread use. Therefore, this study aims to assess the knowledge, attitude, and perception of dental students and dentists regarding the possible applications of AI in the field of Oral Medicine and Radiology. Materials and methods: This was a cross-sectional questionnaire-based study comprising 15 questions circulated through Google Forms® to 460 dental students and professionals. The questionnaire collected demographic data of participants and assessed their knowledge, perception, and attitude about AI in Oral Medicine and Radiology answered using a 5-point Likert scale. Responses obtained were statistically analyzed using descriptive statistics and a chi-square test. Results: Out of 460 participants, majority had an idea about AI (94.13%) and its working principle (73.30%). Participants agreed that AI can be used in the diagnosis and formulating of treatment plans (88.47%), early detection of cancer (77.82%), forensic dentistry (74.13%), and as a prognostic (80.65%) and quality control tool (81.30%). A majority felt that AI should be incorporated into the dental curriculum (92.39%) and most of them were against suggesting AI in clinical incorporation (35.87%) with a fear that AI might replace the clinician in the future (76.52%). Conclusion: Based on the findings of the study, we strongly recommend that further research and insights into AI should be delivered through lectures, curricular courses, and scientific meetings to explore and increase awareness about this fascinating technology