Utility of clinicoradiological, microbiological, histopathological, and molecular methods in the diagnosis of spinal tuberculosis.

PURPOSE: The diagnosis of STB is mainly based on clinicoradiological observations substantiated by bacterial culture, staining, Gene Xpert, and histopathology. The purpose of the study was to correlate these methods to evaluate the effectiveness in the diagnosis of STB. METHODS: A total of 178 clinicoradiologically suspected cases of STB were included in the study. The specimens for diagnostic workup were collected either during surgery or by CT-guided biopsy. All these specimens were tested for tuberculosis through ZN staining, solid culture, histopathology, and PCR. The sensitivity, specificity, PPV, and NPV of each test were calculated using histopathology as a gold standard. RESULTS: Out of the 178 cases, a total of 15 cases were excluded from this study. Among the remaining 163 cases, TB was diagnosed in 143 [87.73%] on histopathology, 130 [79.75%] on Gene Xpert, 40 [24.53%] on culture, and 23 [14.11%] on ZN stain. The sensitivity, specificity, PPV, and NPV of Gene Xpert were 86.71, 70, 95.38, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of AFB culture were 27.97, 100, 100, and 16.26%, respectively. The sensitivity, specificity, PPV, and NPV of AFB stain were 16.08, 100, 100, and 14.29%, respectively. Gene Xpert showed a moderate agreement [Ƙc = 0.4432] with histopathology. CONCLUSION: No single diagnostic modality can ascertain the diagnosis, and it is desirable to have a combination of diagnostic batteries for better results. A combination of Gene Xpert and histopathology aids in early and reliable diagnosis of STB.

Vaccine hesitancy for coronavirus SARS-CoV-2 in Varanasi India.

With the rollout of the world's largest vaccine drive for SARS-CoV-2 by the Government of India on January 16 2021, India had targeted to vaccinate its entire population by the end of 2021. Struggling with vaccine procurement and production earlier, India overcome these hurdles, but the Indian population still did not seem to be mobilizing swiftly toward vaccination centers. The severe second wave has slowed the vaccination pace and was also one of the major contributing factors to vaccine hesitancy. To understand the nature of vaccine hesitancy and its underlying factors, we conducted extensive online and offline surveys in Varanasi and adjoining regions using structured questions. Most respondents were students (0.633). However, respondents from other occupations, such as government officials (0.10), have also participated in the study. Interestingly, most people (0.75) relied on fake news and did not take COVID-19 seriously. Most importantly, we noticed that a substantial proportion of respondents (relative frequency 0.151; mean age 24.8 years) reported that they were still not interested in vaccination. We observed a significant association between vaccine hesitancy and socioeconomic status (χ2 = 307.6, p < 0.001). However, we failed to detect any association between vaccine hesitancy and gender (χ2 = 0.007, p > 0.5). People who have neither been vaccinated nor have ever been infected may become the medium for spreading the virus and creating new variants, which may lead to the vaccine-resistant variant. We expect this extensive survey to help the Government upgrade their vaccination policies for COVID-19 in North India.

Association of multidrug resistance behavior of clinical Pseudomonas aeruginosa to pigment coloration.

Pseudomonas aeruginosa is an adaptable bacterial pathogen that infects a variety of organs, including the respiratory tract, vascular system, urinary tract, and central nervous system, causing significant morbidity and mortality. As the primary goal of this study, we wanted to determine how pigment color production differed between clinical strains of P. aeruginosa, and whether or not that variation was associated with multidrug resistance or the ability to form biofilms. We screened in total 30.1% of yellow, 39.8% green and 30.1% of no pigment-producing P. aeruginosa strains from a total of 143 various clinical isolates. Yellow pigment-producing strains presented significant resistance to antibiotics groups, including ß-lactam (91.5%), aminoglycosides (70.5%), and carbapenems (51.9%) compared to green and non-pigmented strains. Notably, 16.3% of yellow pigment-producing strains were resistant to colistin which is used as a last-resort treatment for multidrug-resistant bacteria, whereas only 2.3% of non-pigmented and 1.8% of green pigmented strains were resistant to colistin. Aside from that, yellow pigment-producing strains were frequent producers of enzymes belonging to the lactamase family, including ESBL (55.6%), MBL (55.6%), and AmpC (50%). Compared to the green groups (7.14%) and non-pigmented groups (28.5%), they had a higher frequency of efflux positive groups (64.2%). Notably, when compared to non-pigmented groups, green pigment-producing strains also displayed antibiotic susceptibility behavior similar to yellow pigment-producing strains. The majority of yellow pigment-producing strains outperformed the green and non-pigmented strains in terms of MIC levels when compared to the other two groups of strains. Despite the fact that previous studies have demonstrated a direct correlation between multidrug resistance behaviors and biofilm production, no such statistically significant association between pigment and biofilm formation was found in our investigation. Our research has demonstrated that the correlation of bacterial pigments on their susceptibility to antimicrobial agents. Yellow pigment-producing P. aeruginosa strains posed a significant problem due to the lack of alternative agents against such transformed strains, which may be associated with the development of multidrug resistance.

Impact of Video Modules-Based Training on Knowledge, Attitude, and Practices of Cleaning and Disinfection Among Housekeeping Staff at a Tertiary Care Center During the COVID-19 Pandemic.

Aim To assess the knowledge, attitude, and practice toward cleaning and disinfection among housekeeping (HK) staff amid the coronavirus disease 2019 (COVID-19) pandemic. Methods A quasi-experimental was undertaken among HK staff at a tertiary care hospital. A 30-item structured questionnaire was used in the study, which consisted of questions pertaining to knowledge (11), attitude (8), and practice (11) toward cleaning and disinfection. Result One-hundred-two participants were included by convenient sampling, with mean age = 30-37 years. There was an improvement in pre-test and post-test knowledge (6.21 to 9.7) and practice score (9.97 to post-test 10.52). However, the attitude score did not show a significant change in the post-test score (p=0.964), showing that they were having a positive attitude toward the practices before training too.  Conclusion Improvement in the post-test score shows that periodic targeted training sessions on cleaning and disinfection among housekeeping staff help improve their knowledge, attitude, and practices toward infection prevention and control (IPC) during the COVID-19 pandemic, thus minimizing the spread of the virus in a hospital environment, reducing their apprehension, and preparing them to work in such pandemic situations.

Expectations of healthcare personnel from infection prevention and control services for preparedness of healthcare organisation in view of COVID-19 pandemic.

BACKGROUND: During infectious outbreaks like COVID-19, it is essential that every healthcare personnel (HCP) strictly adheres to infection prevention and control (IPC) policies. To boost IPC measures, training to reinforce preventive practices, which are pertinent to needs and encompass the expectations of the HCP, is indispensable. Thus, these expectations of the HCP should be explored. METHODS: In this cross-sectional descriptive survey, we used convenience sampling technique to ask the participants to list their expectations on of covid-19 IPC training paper based forms. Using the category construction approach, we organised the expectations and grouped the participants on the basis of their work and place of work to analyse the association using the chi-square test. RESULTS: Many participants expected to learn about the use of PPE and masks, hand hygiene, physical distancing, cleaning and disinfection, basic precautions for personal protection during the training. Expectations also included various administrative queries, sample collection and clinical skills for diagnosis and management. There was significant association of many categories of expectations with the nature and place of work in the hospital. CONCLUSION: When planning IPC training, these expectations of the HCP may be carefully addressed. Information about causative agent, transmission and clinical aspects may will give a contextual meaning to IPC training. Some important preventive measures, which few participants expected to learn must be analysed in detail to understand the attitude of the HCP towards them. Efforts to appraise the HCP for the importance of these measures and promoting its practice may play a vital role to curb the spread of infectious diseases.

Effectiveness of video modules in infection control trainings during COVID-19 pandemic: A quasi-experimental study in tertiary care institute.

BACKGROUND: Continuous pertinent trainings for infection prevention and control (IPC) measures are essential to ensure quality health-care services along with the safety of the health personnel. Amid the COVID-19 pandemic, the current study focusses on the utilization of explicated video modules training of all health-care personnel of the institute and assessment of the effectiveness of video training for IPC practices during COVID-19 pandemic. MATERIALS AND METHODS: A quasi-experimental study, one group pre- and posttest design, using Google Questionnaire forms was conducted at a tertiary care center. The training was assisted by trained tutors, and three in-house videos were demonstrated to the participants regarding specific IPC measures; "Do's and Don'ts;" "Hand hygiene and personal protective equipment's (PPE)" and "Environmental cleaning and disinfection." SPSS software version 23 (IBM Corp., N. Y., USA) was used for the analysis using the descriptive statistics, Chi-square test, Fisher's t-test, ANOVA, and post hoc Tukey's test. RESULTS: The level of knowledge increased significantly by 16% in the posttest. Statistically significant association between the levels of knowledge in pretest as well as posttest scores and age (P < 0.001), designation (P < 0.001), and years of experience (P < 0.001) was identified. The participants were satisfied with the video-assisted trainings and willing to use videos for revision. CONCLUSIONS: Video-assisted training modules similar to this study may be utilized to enhance the knowledge of various cadres of health-care staff regarding IPC practices.

Corona health-care warriors in India: knowledge, attitude, and practices during COVID-19 outbreak.

BACKGROUND: COVID-19 has become a global health emergency after its first case in Wuhan city, China. An increasing number of cases and deaths are challenging the health-care system globally. This study aims to assess knowledge, attitude, and practice toward COVID-19 disease among health personnel in rapid outbreak in India. MATERIALS AND METHODS: A cross-sectional survey was conducted using Google Forms through Google platform on-line. A total of 713 health personal allied health-care staff, working in different public and private health-care facilities, was conducted in the mid of April 2020. A structured knowledge, attitude, and practice questionnaire used to assess health personnel's knowledge, attitude, and practice toward COVID-19. All instruments were validated and pretested before use. Chi-square test, followed by binary logistic and multivariate regression, was applied to determine factors associated with knowledge scores. RESULTS: Seven hundred and thirteen health personnel participated, and 703 (98.6%) participants responded were analyzed for final results. 95.9% of the health personnel were aware about route of transmission and clinical symptoms (95.3%) of COVID-19. 63.7% believed that virus outbreak would be controlled globally and followed standard precautions (81.8%), including wearing the mask. Further, majority (98.3%) of the participants avoided social contact by not going to crowded places and not calling people to their homes (82.2%) during the advisory of the government. In binary logistic regression analyses, the adequate knowledge score found significantly associated with MBBS/bachelor's degree (odds ratio [OR]: 2.309, confidence interval [CI]: 1.232-4.324, P < 0.009) and master's degree (OR: 2.944, CI: 1.485-5.835, P < 0.002), working with government health-care facility (OR: 3.662, CI: 1.624-8.285, P < 0.002), and holding a post of a physician (OR: 7.735, CI: 2.210-27.091, P < 0.001) during outbreak. CONCLUSIONS: The level of education is associated with adequate knowledge scores among the health personnel. Type of health-care facility and post held in a health-care facility are significant predictors of adequacy of knowledge.

Feasibility and usefulness of online virtual training of urology residents in times of COVID-19: A single-center experience and an evidence-based strength, weakness, opportunity, and threat analysis.

BACKGROUND: The COVID-19 disease has resulted in an almost complete shutdown of all services worldwide. Hospitals continued to provide emergency services and treatment for COVID-19 disease. Teaching hospitals like ours had another responsibility at hand; training of our surgical residents. Not allowing this pandemic to take away months of training, we resorted to online virtual training programs, for continuing academic activities. After having conducted thirty such sessions, we took feedback from the participating students and faculty members to evaluate the usefulness of this new initiative and identify the lacunae that needed to be addressed. MATERIALS AND METHODS: The initial twenty classes were held on the GoTo Meeting ® online platform, whereas the last ten were conducted using the Google Meet application. A 20-item questionnaire covering four broad domains of general perception, feasibility, knowledge gained, and drawbacks was circulated, and 19 responses were registered anonymously. Strength, weakness, opportunity, and threat analysis was done based on the responses received. RESULTS: About 89.5% of the participants believed that online classes were the ideal platform for continuing education and 84.2% of the participants were overall satisfied with the whole exercise. The Achilles' heel was the availability of a good Internet connection, and the major lacunae were the poor quality of video and audio transmission. Seventy-four percent of the participants wanted to continue online training in the future too, whereas 26% wanted to revert to the traditional face-to-face teaching. CONCLUSION: Online virtual training classes are an effective and feasible alternative to traditional teaching in times such as these, which demanded strict social distancing. It naturally lacked the warmth and personal touch of the traditional teaching classes, but it allowed us to continue teaching our residents and also prepare them to face the biggest menace of all times.

Effectiveness of Video-Based Online Training for Health Care Workers to Prevent COVID-19 Infection: An Experience at a Tertiary Care Level Institute, Uttarakhand, India.

Purpose Amidst the current COVID-19 pandemic, traditional teaching methodology took a back foot. However, an urgent need for training health care worker (HCW) on preventive measures for COVID-19 infection was the need of the hour. Keeping in mind the precautionary measures required to combat COVID-19 infection, the only promising option for training was by adopting an online learning method. This study was undertaken to determine the effectiveness of video-based training using online platforms for infection prevention and control (IPC) training during the COVID-19 pandemic. Methods A quasi-experimental study, with only one experimental group comprising of HCWs, was undertaken to assess the effect of intervention which included video-assisted teaching-learning regarding IPC measures with a special focus on COVID-19 at a tertiary care Institute in North India. Online sessions were conducted on Do's and Don'ts, Hand Hygiene, donning and doffing of personal protective equipment (PPE), cleaning and disinfection, and bio-medical waste (BMW) management with the help of pre-recorded videos which was pre-validated. The session was followed by online interaction with participants by a single resource person. Pre-test and post-test were conducted through google forms before commencement and at the end of the online session respectively. The data were analyzed in terms of descriptive frequencies and percentages of different domains to describe the pre- and post-test knowledge. Results A total of 576 participants were included in the study. There was a statistically significant gain in scores of all questions related to cleaning and disinfection; and BMW. No significant change was observed in knowledge regarding the sequence of doffing (p-value: 0.94). The result of pairwise comparisons pre-test and post-test scores showed that intervention through video-assisted teaching-learning resulted in improvement of knowledge which was found to be statistically significant (p-value < 0.001). Conclusion Video-assisted teaching-learning through virtual platforms effectively trained health personnel on infection prevention and control practices during the COVID-19 pandemic. Video-assisted training can successfully be handled by a single resource person to impart the knowledge and skill to the trainee. Virtual teaching and learning is a feasible and efficient method to deliver training to HCWs on infection control practices and this methodology may be adopted in the future for several other training in manpower crunch situations, similar restrictive circumstances as posed by the COVID-19 pandemic.

Mixed invasive fungal infections among COVID-19 patients.

Background and Purpose: The healthcare system in India collapsed during the second wave of the COVID-19 pandemic. A fungal epidemic was announced amid the pandemic with several cases of COVID-associated mucormycosis and pulmonary aspergillosis being reported. However, there is limited data regarding mixed fungal infections in COVID-19 patients. Therefore, we present a series of ten consecutive COVID-19 patients with mixed invasive fungal infections (MIFIs). Materials and Methods: Among COVID-19 patients hospitalized in May 2021 at a tertiary care center in North India, 10 cases of microbiologically confirmed COVID-19-associated mucormycosis-aspergillosis (CAMA) were evaluated. Results: All patients had diabetes and the majority of them were infected with severe COVID-19 pneumonia (6/10, 60%) either on admission or in the past month while two were each of moderate (20%) and mild (20%) categories of COVID-19; and were treated with steroid and cocktail therapy. The patients were managed with amphotericin-B along with surgical intervention. In total, 70% of all CAMA patients (Rhizopus arrhizus with Aspergillus flavus in seven and Aspergillus fumigatus complex in three patients) survived. Conclusion: The study findings reflected the critical importance of a high index of clinical suspicion and accurate microbiological diagnosis in managing invasive dual molds and better understanding of the risk and progression of MIFIs among COVID-19 patients. Careful scrutiny and identification of MIFIs play a key role in the implementation of effective management strategies.

Candida tropicalis in the tropics: A rare fungal cause of perinephric abscess.

Perinephric and renal abscess are very rare entities with insidious presentation and pose a great diagnostic challenge, common etiology being bacterial. Only less than 30 cases of fungal etiology have been reported in literature. Herein, we report first case of fungal perinephric abscess caused by Candida tropicalis in a young diabetic female who presented with right flank pain and vomiting. Diagnosis made by CT imaging and culture of USG guided aspiration of perinephric abscess revealed growth of Candida tropicalis. Candida tropicalis perinephric abscess requires a very high index of suspicion for diagnosis. Associated high morbidity and mortality rates are likely due to misdiagnosis, therefore fungal perinephric and renal abscess must be kept as differential diagnosis in cases of fever with abdominal pain. Prompt diagnosis and early treatment are important for better outcome. Imaging and microbiological investigations are required for diagnosis, and drainage is indicated for successful therapy.

Genetic Association of ACE2 rs2285666 Polymorphism With COVID-19 Spatial Distribution in India.

Studies on host-pathogen interaction have identified human ACE2 as a host cell receptor responsible for mediating infection by coronavirus (COVID-19). Subsequent studies have shown striking difference of allele frequency among Europeans and Asians for a polymorphism rs2285666, present in ACE2. It has been revealed that the alternate allele (TT-plus strand or AA-minus strand) of rs2285666 elevate the expression level of this gene upto 50%, hence may play a significant role in SARS-CoV-2 susceptibility. Therefore, we have first looked the phylogenetic structure of rs2285666 derived haplotypes in worldwide populations and compared the spatial frequency of this particular allele with respect to the COVID-19 infection as well as case-fatality rate in India. For the first time, we ascertained a significant positive correlation for alternate allele (T or A) of rs2285666, with the lower infection as well as case-fatality rate among Indian populations. We trust that this information will be useful to understand the role of ACE2 in COVID-19 susceptibility.

Clinical spectrum and risk factors for hospital-acquired septicemia in a tertiary care centre of North-East India.

INTRODUCTION: Although several studies have shown an increasing prevalence of sepsis due to multidrug-resistant organisms, specific data on hospital-acquired septicemia is lacking. MATERIALS AND METHODS: An observational prospective study was carried out for a duration of 1 year in which patients developing hospital-acquired septicemia were included and their disease spectrum and associated risk factors were analyzed. RESULTS: Among a total of 350 patients, 145 came out to be culture positive. Genitourinary infections were the most common infections encountered in this study, whereas the presence of invasive device came out to be the most prevalent risk factor. CONCLUSION: Septicemia is still a rising problem; hence, we should manage it carefully. Coagulase-negative Staphylococci can no longer be considered as contaminants and it should be treated as pathogens.

Immune Dysfunction and Multiple Treatment Modalities for the SARS-CoV-2 Pandemic: Races of Uncontrolled Running Sweat?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a global pandemic threat with more than 11.8 million confirmed cases and more than 0.5 million deaths as of 3 July 2020. Given the lack of definitive pharmaceutical interventions against SARS-CoV-2, multiple therapeutic strategies and personal protective applications are being used to reduce the risk of high mortality and community spread of this infection. Currently, more than a hundred vaccines and/or alternative therapeutic regimens are in clinical trials, and some of them have shown promising results in improving the immune cell environment and controlling the infection. In this review, we discussed high-performance multi-directory strategies describing the uncontrolled deregulation of the host immune landscape associated with coronavirus disease (COVID-19) and treatment strategies using an anti-neoplastic regimen. We also followed selected current treatment plans and the most important on-going clinical trials and their respective outcomes for blocking SARS-CoV-2 pathogenesis through regenerative medicine, such as stem cell therapy, chimeric antigen receptors, natural killer (NK) cells, extracellular vesicular-based therapy, and others including immunomodulatory regimens, anti-neoplastic therapy, and current clinical vaccine therapy.

Rational use of face mask in a tertiary care hospital setting during COVID-19 pandemic: An observational study.

Masks play a role in the protection of health-care workers (HCWs) from acquiring respiratory infections, including coronavirus disease 2019 (COVID-19) in health-care settings. This observational study was conducted among 382 HCWs in a tertiary care setting over a period of 1 month. Descriptive analysis was done to assess the rational and recommended use of masks/respirators during COVID-19 pandemic using a structured observation checklist as a survey tool. A total of 374 HCWs were included, 64.9% of whom were using face masks rationally as mentioned per risk area categorization with a predominance of triple-layered mask during all 4 weeks. Overall, 64.1% used masks correctly. Clear guidelines and strategies can help to increase the compliance of HCWs with rational use of face masks.

Comparative evaluation of microscan walkaway 96 plus ID/AST system and mikrolatest broth microdilution kit in assessing In vitro colistin susceptibility of carbapenem-resistant clinical gram-negative bacterial isolates: Experience from a tertiary care teaching hospital in Rishikesh, Uttarakhand.

Context: As reports on colistin resistance are slowly emerging from different parts of the world, it is imperative that the clinical microbiology laboratories should generate accurate in vitro colistin susceptibility results. Aim: The aim is to generate preliminary data on the diagnostic utility of MicroScan WalkAway 96 Plus Identification ID/ Antimicrobial susceptibility testing AST system in determining in vitro colistin susceptibility of carbapenem-resistant clinical Gram-negative bacterial isolates. Settings and Design: A pilot study was conducted in a tertiary care teaching hospital located in Rishikesh, Uttarakhand, between May and June 2019. Materials and Methods: Thirty-four carbapenem-resistant Escherichia coli, Pseudomonas aeruginosa and Acinetobacter spp. isolated from various non-repetitive clinical samples during the study period, were subjected to antibiotic susceptibility testing using MicroScan ID/AST system. Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry was used to confirm identity of these isolates. Additional colistin susceptibility testing of all test isolates was performed using Mikrolatest minimum inhibitory concentration antibiotic susceptibility testing kit (reference method), which is based on broth micro dilution (BMD) principle. Statistical Analysis Used: Fisher's exact test. Results: 11.8% (4/34) of the test isolates (100% [2/2] Acinetobacter junii, 10% [1/10] E. coli and 14.3% [1/7] P. aeruginosa respectively) exhibited in vitro colistin resistance by BMD method. Categorical agreement between MicroScan ID/AST system and Mikrolatest kit w. r. t in vitro colistin susceptibility test results was as follows: 71.4% (Acinetobacter baumannii), 85.7% (P. aeruginosa) and 100% (A. junii, A. johnsonii, E. coli and Klebsiella pneumoniae), respectively. Two major errors (MEs) for A. baumannii and one very ME for P. aeruginosa respectively were observed. Conclusions: Data generated by this study will be of help to the clinicians who are often faced with the dilemma of treating multi drug resistant infections with limited treatment options.

Morbidity profile of orphan children in Southern India.

BACKGROUND: Orphan children globally and in India are increasing. Magnitude of their health problems is unknown. The present study was carried out to assess the morbidity pattern of orphan children aged 10-16 years, assess their knowledge about signs and symptoms of common childhood morbidities and treatment-seeking practices. METHODS: One hundred institutionalized orphan children aged 10-16 years were studied for 6 months. Data was collected by trained investigators regarding sociodemographic background, awareness about common morbidities and treatment seeking practices. Thorough clinical examination and anthropometric measurements were done. Distribution of morbidities was shown. RESULTS: 80% of the boys and 68% of the girls had low BMI. 78% suffered from multiple morbidities of which 76% had infections of skin and appendages while 74% had ear problems. 26% had diarrhea and 21% had B-complex deficiency. The mean duration of all diseases was 7±1.1 days. Awareness about diseases and their complications was low; and self-care was highly prevalent for most health problems. CONCLUSIONS: Orphan children in South India suffer from many morbidities about which their awareness and treatment seeking is low.