Bacterological Profile of Neonatal Septicemia with special emphasis on Plasmid Mediated Amp C β Lactamase Producing Gram Negative Isolates.

INTRODUCTION : Neonatal septicemia is a major cause of morbidity and mortality in the newborn1. Neonatal septicemia is classified into early onset septicaemia (EOS) and late onset septicemia (LOS) based on the age at onset. World Health Organization (WHO) estimates that there are about 5 million neonatal deaths occur globally per year. Ninety eight percent of them are occurring in developing countries. Neonatal Death rate varies in developing countries between 11-68/1000 live birth. The most common causes of death in neonatal period is infection (32%) followed by birth asphyxia (29%) and prematurity (24%). Neonatal infections currently cause 1.6 million deaths in developing countries. In India septicemia occur in 10.97-27/1000 live births and is the leading cause of neonatal mortality, accounting for one quarter to nearly half of all neonatal deaths. In Tamil Nadu as per the study Kuruvil et al the incidence of neonatal septicemia is 9.8 per 1000 live birth Vellore. AIMS AND OBJECTIVES : AIM: The aim of the present study is to identify the common Bacterial isolates of neonatal septicemia and their antibiotic susceptibility patterns with special reference to plasmid mediated AmpC β-lactamase producing Gram negative isolates and also compare the CRP level with culture positivity. OBJECTIVES : 1. To determine the bacteriological profile of neonatal septicemia. 2. To evaluate the antimicrobial susceptibility pattern of organisms isolated from neonatal septicemia. 3. To identify the prevalence of ESBL producers among the Gram negative isolates of neonatal septicemia. 4. To identify the prevalence of plasmid mediated AmpC β-lactamase producers among the Gram negative isolates of neonatal septicemia. 5. To compare the CRP level with culture positivity. MATERIALS AND METHODS : This prospective study was conducted on 273 Neonates with signs and symptoms of septicemia admitted in Neonatal Intensive Care Unit at Coimbatore medical college & Hospital, Coimbatore over the period of 14 months from May’2008 to June’2009. Approval was obtained from the ethical committee prior to conduct of this study. Informed consent was obtained from the parents of neonates. Inclusion criteria: Age30 weeks of gestation & Full term babies, Presence of three or more clinical symptoms and signs of septicemia like lethargy, poor feeding, irritability, fever, vomiting, abdominal distension, jaundice, respiratory distress, hypothermia, cyanosis and convulsions. Exclusion criteria: Extreme prematurity <30 wks of gestation, Gross congenital anomalies, Undergone surgery. The name, age, sex, address, date of admission, inpatient number and detailed clinical history of the patients were noted. A thorough head to foot general examination, systemic examination and Respiratory Distress Syndrome (RDS) scoring were carried out by the pediatricians. RESULTS : During the study period, 273 neonates with signs and symptoms of septicemia admitted at Neonatal Intensive Care Unit, Coimbatore Medical College & Hospital were investigated with Blood culture & sensitivity and CRP assay. The Resistant Bacterial isolates were analyzed for ESBL and plasmid mediated AmpC β-lactamase enzyme production by conventional Microbiological methods. The Male : Female Neonates ratio of this study was 1.1:1. Out of 273 neonates, 173 (63 %) were less than 7 days old (EOS) and 100(37%) were in between 7-28 days after birth. (LOS). CONCLUSION : The study of bacteriological profile of neonatal septicemia revealed early onset septicemia as more common than late onset septicemia. Klebsiella pneumoniae was the most common bacterial isolate followed by Staphylococcus aureus, CONS, Escherichia coli, Enterobacter spp, Pseudomonas aeuriginosa, Acinetobacter spp and Streptococci spp in causing neonatal septicemia. Single CRP level measured at the onset of infection lacked sufficient sensitivity to beuseful in identifying neonatal septicemia. Antimicrobial susceptibility revealed Imepenam as the most effective antibiotic followed by Cefoperazone + Sulbactum, Cefepime and Amikacin against Gram negative isolates. Among the Gram negative isolates of the neonatal septicemia 27% were ESBL producers and 22% were plasmid mediated AmpC β-lactamase producers. Failure to distinguish AmpC β-lactamase producers from ESBL producers will lead to inappropriate antimicrobial treatment and may result in increased mortality. The ability to detect and distinguish between AmpC and ESBL producing organisms has therapeutic importance as well as epidemiological significance

A Study on Estimating Prevalence of Spontaneous Bacterial Peritonitis in Asymptomatic Outpatients with Cirrhotic Ascites undergoing Therapeutic Tapping

INTRODUCTION: Spontaneous bacterial peritonitis (SBP) is most common, potentially lethal and characteristic infectious complication of cirrhosis. SBP is defined as the presence of infection in ascetic fluid in absence of any distinguishable secondary cause of peritonitis. The profile of SBP may differ with different ethnic groups, geographic factors, social factors and etiological factors. Although there is evidence of SBP, from both the developed and developing nations, there has not been any study conducted in India to find out the occurrence of SBP, especially in southern part of India and in a tier II city like Coimbatore. Hence, we intended to conduct this to assess the frequency of Spontaneous Bacterial Peritonitis in asymptomatic outpatients with cirrhotic ascites, through the analysis of ascetic fluid. This further aimed to study the variations in CLD patients and relationship of different signs, symptoms or laboratory outcomes with the presence of SBP. OBJECTIVES: To assess the frequency of Spontaneous Bacterial Peritonitis and to analyse ascitic fluid and serum values of asymptomatic outpatients with cirrhotic ascites. METHODOLOGY: This is cross sectional study done among the Medicine OPD patients of CMCH, Coimbatore Hospital presenting with the cirrhosis and ascites. This study was conducted over 18 months (March 2018-March 2019) among 50 individuals. RESULTS: In this study, 48% of the subjects had cirrhosis due to alcohol followed by 24% due to HCV, 14% due to HCV & alcohol and 14% were cryptogenic. In this study, 68% of the subjects showed negative in their ascitic fluid culture. Of the remaining 32% who showed positive in their ascitic fluid culture, 16% showed Staph. aureus and 16% showed Staph. Viridians. 30% of the subjects showed negative for spontaneous bacterial peritonitis. Of the remaining 70% who showed positive for spontaneous bacterial peritonitis, 32% had culture positive neutrocytic ascites and 38% showed culture negative neutrocyticascites. 62% of the subjects were hospitalized and out of them 56% received cefotaxime antibiotic and 6% received Norfloxacin antibiotic. CONCLUSION: Among subjects with Child’s score class C, 100% subjects had SBP. Also there is significant relationship between Child’s score and SBP. Serum sodium, albumin, bilirubin, ascitic fluid protein and total leucocyte count were significantly different among the SBP patients and hence these values can be considered as early predicting markers of SBP in patients with cirrhosis

A Cross Sectional study on Changes in the Iris of the Patients with Uterine Fibroids

BACKGROUND: Uterine fibroids (myomas or leiomyomas) [UF] are benign, monoclonal tumors of the uterine smooth muscle cells. Abnormal bleeding, pelvic masses, pelvic pain, infertility, bulk symptoms, and obstetric complications are some of the clinical manifestations. Due to symptoms, nearly one-third of women with leiomyomas will seek treatment. Rates of inpatient hospitalization for UF in the United States increased steadily by age from 1998 to 2005, peaking among women aged 45–49 years (6.3 per 1,000 person-years). People today require preventative health care and less difficult techniques for assessing their health. Iridology is a noninvasive, painless, and cost-effective method of checking into the body that can be used in conjunction with any other diagnostic technique. However, no known study has reported changes in the iris in uterine fibroid patients. METHODS: This observational cross-sectional study was carried out among 60 females aged 30 to 55 years. An interactive introductory lecture about the purpose of the study was explained to the subjects. After obtaining the written consent, they were subjected to detailed history taking, and their iris images were captured and documented using a 12 MP iridology camera with pro-iris software. RESULTS AND CONCLUSION: This study revealed that the iris changes in the uterine area of the right iris is about 83.33% and left iris is 60%, concluding that iris diagnosis can be a pre-diagnostic tool in the diagnosis of uterine fibroids

The dementia experiences of people from Caribbean, Chinese and South Asian communities in Bristol

This report is the product of an eight-month research project funded by Bristol City Council which set out to establish the dementia experiences and needs of people of Black and other Minority Ethnic (BME) origins. The study was overseen by the Bristol BME and Dementia research group, which was made up of representatives from Bristol and Avon Chinese Women’s Group, Alzheimer’s Society, the University of the West of England, Bristol City Council, Bristol Black Carers and Bristol Dementia Wellbeing Service (BDWS)

Diversity, distribution and seasonal variation of seaweeds in Southwest coast of Peninsular India

Six different research locations around the southwest coasts of Tamil Nadu and Kerala were used for the current investigations on the diversity, distribution, and seasonal fluctuation of seaweeds (India). A total of 73 Chlorophyta, Ochrophyta and Rhodophyta were recorded under 23 families and 38 genera. The study site Rasthakaadu (53) was with the maximum number of seaweeds followed by Kanniyakumari (51). Out of six study sites, four study sites (Rasthakaadu, Kanniyakumari, Muttom, Kurumpanai) were dominant with Rhodophyta in contrast to the other two study sites (Vallavilai, Vizhinjam) in which Chlorophyta was dominant. Chlorophyta such as Chaetomorpha antannina, C. indica, C. media, Ulva fasciata, U. lactuca, brown seaweeds Sargassum ilicifolium and red seaweed Gracilariopsis longissima were commonly seen in the study area. Chaetomorpha indica (Chlorophyceae) was recorded as the most dominant species in season I, whereas Sargassum ilicifolium (Phaeophyaceae) was considered as the most dominant seaweed taxon in seasons II and III. The seasonal variation in physicochemical parameters of seawater had much influence on the growth of seaweeds. Comparing the eastern Coromandel Coast of peninsular India to the western Malabar Coast, it has been found from the current study that the eastern Coromandel Coast was rich in seaweed. Moreover, the study shows that the topography and seasonal change of the physicochemical characteristics of seawater at a given site were the key determinants of seaweed richness. Anthropogenic activities, like Nuclear power plants (Koodankulam), sand mining, construction works, dumping of plastics etc., also affected the potential growth of seaweeds thereby reducing the sustainability of the natural resource

EFEK EKSTRAK ALOE VERA TERHADAP CANDIDA ALBICANS YANG DIISOLASI DARI RONGGA MULUT PENDERITA HIV/AIDS DENGAN TEKNIK TUBE DILUTION : EFFECT OF ALOE VERA LEAF EXTRACT TO CANDIDA ALBICANS ISOLATED FROM ORAL CAVITY OF HIV/AIDS PATIENTS BY TUBE DILUTION TECHNIQUE

Oral candidiasis is the third major opportunistic infection in people with HIV/AIDS. The antifungal has a very important role to prevent candidemia. But the use of antifungal has developed resistancy, for this reason it is important to find other high potent and cost effective antifungal. In this study Aloe vera was choosen because of its beneficial properties which has already been proven scientifically. The objective of the study was to investigate antifungal effect by finding the minimal inhibitory concentrations (MICs) and minimal fungicidal concentrations (MFCs) of Aloe vera leaf to Candida albicans isolated from oral cavity of HIV/AIDS patients, and to Candida albicans ATCC 10231 strain as the control group. Ethanol was used for the extraction of the leaf after obtaining the gel from it. MICs and MFCs were tested by tube dilution technique. Eight identified samples of Candida albicans isolated from oral cavity of HIV/AIDS patients. The result showed that from 3 samples had MIC 25%, and 4 samples 50%. MFC showed 1 sample in 12.5%, 3 samples in 100%, but 4 samples could still grow in 100% concentration with different number of colony forming units. As the control group, Candida albicans ATCC 10231 showed MIC in 25% and MFC in 75%. In conclusion, aloe vera plants seem to have promising role to cure oral candidiasis in HIV/AIDS patients because of its antifungal and immunomodulatory properties

Socioepidemiologic Profile and Treatment-seeking Behaviour of HIV/AIDS Patients in a Tertiary-care Hospital in South India

India has the third largest number of people living with HIV/AIDS. Provision of free antiretroviral therapy (ART) for eligible persons living with HIV (PLHA) has been scaled up significantly both in terms of facilities for treatment and number of beneficiaries. This study aimed at describing the profile of HIV/AIDS patients on ART from a tertiary-care hospital and to explore the factors associated with treatment-seeking behaviour, family support, and perceptions regarding HIV and ART. This is a descriptive study conducted at the ART centre in a tertiary-care hospital in Puducherry. Study population consisted of 130 HIV-positive patients aged more than 18 years on free firstline ART for at least 6 months. Data on sociodemographic details, clinical details, treatment-seeking behaviour, family support, and perceptions regarding HIV and ART were collected using a pretested questionnaire. Data are presented as percentages. In total, 130 patients on ART for at least 6 months were included in the study\u201461% were males (n=79), 39% were females (n=51); half of them belonged to the age-group of 36-50 years. Half of the participants were diagnosed to have HIV/AIDS between 1 and 3 year(s); two-thirds had one or more co-infection(s). The majority were aware of the side-effects of ART. After advice to start ART, there was a delay in starting treatment in one-fifth of the subjects due to depression, fear of stigma, disclosure to family, and side-effects. More than two-thirds of the patients travelled more than 30 km distance. Families of HIV-positive subjects were supportive in accompanying to the ART centre, collecting drugs, reminders to take medication, and motivation to complete the treatment. Alcohol (50%) and tobacco consumption (39%) was common among the subjects. Half of the respondents stated stigma, death, and pain as the main fears, and all of them stated high levels of trust and rapport with their doctors. This study reveals several positive aspects among ART beneficiaries. However, issues, like tobacco and alcohol consumption, travelling long distance for drug collection, fear of stigma and death, and concerns regarding the future, need to be addressed

Awareness and practices on eye effects among people with diabetes in rural Tamil Nadu, India.

Background: Recently eye effects of Diabetes Mellitus (DM) are an important concern due to increase in its trend especially in developing countries. Objectives: To assess the awareness related to eye effects of DM and its prevention practices among people with diabetes. Methods: This cross sectional study was conducted from January 2013 to April 2013 in Villupuram district of Tamil Nadu, India. All 105 people with diabetes from the service area of two sub-centres were included. Data on socio demographic details, history of DM, awareness on systemic complications of DM, effects of DM on eyes, practice on regular blood check-up, eye examination and source of information were collected by interview technique using a structured questionnaire. Univariate and multiple logistic regression analysis were done to assess the association of awareness of eye examination with socio-demographic variables. Results: Mean age of the study population was 56.7 years. About 93 people with diabetes (88.6%) tested their blood sugar at least once in every 3 months. About 80 people with diabetes (76.2%) were aware of at least one systemic complication of DM. Although 78 (74.3%) people with diabetes were aware that DM could affect the eyes, majority of this group (68, 87.2%) did not know the specific effects of DM on eyes. In this group, about 28(35.9%) people with diabetes were not aware of the reasons for eye effects, while others mentioned that persistent high blood sugar level (n=26, 33.3%), longer duration of DM (n=14, 17.9%) and lifestyle (n=10, 12.8%) were the reasons for the eye effects of DM. Only 31 (29.5%) of them knew that their eyes must be regularly examined. People with diabetes who had post-secondary and above (&gt;10th standard) level of education had significantly higher awareness on examination of eye (Adjusted OR=19.63). Conclusion: Although awareness of people with diabetes on systemic effects of DM was more, their awareness on specific eye effects and need for regular screening was low. Systematic efforts are required to increase awareness on eye effects and importance of regular screening in this population

Impact of COVID-19 pandemic on maternity services and challenges faced by pregnant women delivering at a tertiary care centre in South India

Background: Coronavirus disease 2019 (COVID-19), was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. India entered a nationwide lockdown on March 25, 2020, disrupting regular health services. Hence this study was conducted to estimate the impact of the COVID-19 pandemic on maternity services and to describe the challenges faced by pregnant women. Methods: A descriptive cross-sectional study conducted from July 2020 to October 2020 at tertiary care hospital, Puducherry, India. 422 pregnant women delivered during this period were included and detailed questionnaire was administered regarding antenatal, intrapartum, postnatal services and, challenges faced during the pandemic via telephonic call. Responses were documented in Epicollect version 5, transferred to Microsoft excel and analysed using Stata version 14.2. Continuous variables were expressed as mean (SD), and Categorical variables as proportions. Results: The 100% response rate was achieved with 32.5% high risk pregnancies. The 71.8% women availed direct emergency medical services while 28.2%. were referrals. The 79.9% and 25% of the women in third trimester had less antenatal visits and discontinued haematinics respectively. The 47.4% had first trimester testing, 30% didn’t receive lactation support. 81% and 69% of primiparous and multiparous women respectively had adopted postpartum Intrauterine contraceptive device as contraception. The 35-50% women faced challenges in availing essential obstetric care services.Conclusions: Development of robust linkage system between existing primary healthcare and tertiary care for managing both low and high-risk pregnancies is of paramount importance to alleviate maternal and perinatal mortality and morbidity.