Detection and prevalence of extended spectrum ?-lactamases in gram-negative bacteria at our health-care center

Background: Emergence of extended spectrum ?-lactamase (ESBL) producing strains of Gram-negative bacteria can lead to serious infections frequently complicates the clinical and treatment outcome. Aims and Objectives: The purpose of this study was to know the prevalence of ESBLs and to know the most common Gram-negative bacteria, which produce ESBLs at our health-care facility. Materials and Methods: This study comprised all of the isolates of Gram-negative bacteria that were acquired from various clinical samples. For the purpose of the investigation, a sample of an isolate that showed resistance to two or more third-generation cephalosporins was taken. ESBL detection and antibiotic sensitivity tests were carried out using conventional microbiological techniques. Results: We isolated a total of 284 Gram-negative bacteria and 54 (19%) were identified as ESBL producers. Out 54 ESBL producers, 18 (33%) isolates were Escherichia coli, 11 (20%) were Pseudomonas aeruginosa, 12 (22%) were Klebsiellae, 6 (11%) were Enterobacter, 2 (4%) were Citrobacter, 4 (8%) were Acinetobacter, and 1 (2%) were Serratia spp. Conclusion: Clinical decision-makers can make the best antibiotic treatment by regularly monitoring multi-drug resistant bacteria like ESBL producers. This also helps to improve infection control procedures. In addition, we must maintain reserve medications like carbapenems on hand for judicial use.

Impact of health education on knowledge and attitude of self-breast examination among female nursing students

Background: Breast cancer is the most common cancer among women and a leading cause of death worldwide, including in India. Breast cancer usually shows a slow development rate, and when recognized in the early stages, successful treatment results can be achieved. Breast self-examination is a screening option for young women. Objective: To assess the impact of health education on knowledge and attitude of self-breast examination among nursing students. Study Design: The present interventional study was conducted between September and October 2019. Setting: This study was done among 79 nursing students of a tertiary care hospital situated in a central district of Uttar Pradesh. Main Outcome Measures: The self-reported pre-designed and structured questionnaire was used. It included three sections Sociodemographic profile Knowledge regarding self-breast examination (SBE) 3. Attitude regarding self-breast examination (SBE). Knowledge and attitude scores were calculated and divided into the poor, average, and good categories. Results: There were 87.3% of girls had prior knowledge of the self-breast examination, while 12.7% of girls were not aware of the self-breast examination. Postintervention, there was a significant increase (p<0.05) in their knowledge about self-breast examination. Conclusion: Planned teaching intervention had a significant impact on the knowledge and attitude of self-breast examination.

Assessment of the utilization of health services among urban slum population in Southern Rajasthan

Background: Urban slums consist of the vulnerable population for whom the affordability and accessibility of health care is constrained due to various reasons. The occurrence of various diseases in slums can be prevented by increasing access as well as utilization of available health care services. Objectives: The aim of the study was to assess the sociodemographic profile of families residing in a selected urban slum area and to study the association between sociodemographic characteristics of families with utilization of available health services by them. Materials and Methods: A cross-sectional study was conducted from May 2013 to December 2013 among 300 families residing in selected urban slums. The information regarding sociodemographic factors and utilization of health services, causes of non-utilization of health services, and preferred mode of treatment during the past 6 months were collected from the head of the family. The association of sociodemographic factors with utilization of health services was tested using Chi-square test. Results: There were 898 (53.20%) males and 790 (46.80%) females in 300 selected families. It was found that 84 (28.00%) head of family were illiterate and 216 families (72.00%) belonged to lower socioeconomic status. The number of families not using any type of health facility was 82 (27.33%). Conclusion: The literacy level of the head of family and socioeconomic status of family was found significantly associated with utilization of health services. Hence, focus should be given to improve the education level and behavior of the persons to adopt the health services and increase the efficiency of the health system.

Two Rarities Together: A Free Peritoneal Body In A Hernia En Pantaloon Sac And Case Series Of Our Experience Of Finding Loose Peritoneal Bodies

Peritoneal loose bodies (PLBs) are rare findings that were reported extensively in the early nineteenth and twentieth century in the form of case series by Littre, Riedel and Macintosh. In the recent past, focus has shifted more towards symptomatic free peritoneal bodies. Although a proper intrabdominal examination and histopathology can help to clear the diagnosis, there is still no consensus in the surgical circle as to how to deal with them. Here, we report a case series of 4 cases of finding loose peritoneal bodies during intra-abdominal procedures, three of them were found during laparoscopic procedures (laparoscopic appendectomy, Robotic mesh rectopexy and laparoscopic bowel resection) while one was an open surgery (open inguinal hernia repair). This paper is unique as for the first time in the history it brings two surgical rarities together i.e. ‘hernia en pantaloon’ and free peritoneal body along with recommendations based on the literature, review to diagnose and treat loose peritoneal bodies.

Type 2 Reaction Continuing after 15 Years of MDT in an Atypical Pattern: A Case Report

Type 2 reactions may occur in the early stages of the anti-leprosy treatment, however, many cases may present 2–3 years after leprosy diagnosis. Some of such patients have been reported to develop episodes as late as 7 years after starting treatment. A 45 years old male, with a past history of intake of multi drug therapymultibacillary (MDT-MB) pack 15 years back presented with fever, generalized bodyache along with development of vesiculo-bullous lesions over the existing annular lesions of borderline lepromatous (BL) leprosy. Possibility of relapse was ruled out clinically as well as histopathologically and the patient was successfully treated with tapering doses of steroids as a case of severe type 2 reaction. Type 2 reaction is less commonly seen in BL leprosy as compared to lepromatous lepromatous (LL) leprosy. Moreover, development of vesiculo-bullous lesions in an annular pattern over existing lesions of BL leprosy as a manifestation of type 2 reaction has rarely been reported in literature. This case is even rarer as the patient is continuing to get type 2 reaction even after 15 years of completion of MDT-MB and that too in an annular pattern over the existing lesions.

A Study Of Reproductive Health Needs Of Adolescent Girls Of UHTC Field Practice Area, Govt. Medical College, Bhavnagar.

Background and Aim: The World Health Organization (WHO) defines an Adolescent as “an individual between 10-19 years of age”. As adolescents are not a homogenous group, their needs vary with their sex, stage of development, life circumstances & their socioeconomic conditions. Inspite of existing Adolescent Friendly Health Services (AFHS), adolescents are reluctant to utilize them because of lack of privacy & confidentiality. Aims of this study are (1) To study reproductive health needs of adolescent girls (2) To assess awareness & utilization of AFHS. Methodology: Community based cross sectional study was conducted in Urban Health Training Centre (UHTC) field practice area of Govt. Medical College, Bhavnagar among 532 Adolescent girls during February 2014 to August 2014. Information about their reproductive health needs, awareness about AFHS & its utilization were collected by pretested prestuctured questionnaire. Data entry & analysis done in Epi info software (version3.2). Results: In the present study regarding reproductive health needs, more than half (54.71%) girls desired correct information about reproductive health system , problems & hygiene & most of the girls (53.20%) choose seminar as best source to provide such information. 21.99% girls desired supply of sanitary pads at lower cost than market. An important finding was that very few (14.1%) girls were aware of AFHS. Among those who were aware of AFHS, 38.67% girls had visited & satisfied with services. The major reason for not utilizing AFHS was shyness among 54.35% girls. Conclusion: Information about reproductive health (54.71%) & supply of sanitary pad at lower prices than market (21.99%) are two important reproductive health needs of adolescent girls. Awareness & utilization of AFHS is very less among adolescent girls due to various barriers.

Energy and Protein Intake During Pregnancy in Relation to Preterm Birth: A Case Control Study.

Objective: To find the association of maternal energy and protein intake with preterm birth. Design: Case-control study. Setting: Two hospitals at Lucknow in Northern India. Participants: Cases (n=350) were defined as mothers (age 18-40 y) of singleton live preterm (<37 wks) neonates. Controls (n=350) were mothers who delivered a singleton neonate, consecutive to enrolled case, after completing 37 weeks of gestation. Results: There was a statistically significant lower mean (SD) energy intake [cases 1624 (249) Kcal vs. controls 1911 (341) Kcal; P<0.001] and protein intake [cases 32.1 (6.1) vs. controls 37.2 (7.0); P<0.001] among women who delivered preterm neonates. Maternal energy and protein intake had significant positive correlation with neonatal weight, length, foot length, head circumference and chest circumference. Conclusion: Lower energy and protein intake during pregnancy is possibly associated with preterm birth.

Hand-made Cloning: A Guide for Cloning Water Buffaloes.

The present review is a detailed discussion on comparable benefits of hand-made cloning (HMC) technique than micro-manipulation based conventional cloning and developed in the author’s laboratory. Hand-made cloning technique does not require micromanipulators, because the manipulations required for both enucleation and nucleus transfer are performed by hand. The HMC technique includes manual bisection of zona-free oocytes and the simultaneous fusion of the somatic cell with two cytoplasts to produce a cloned embryo. The benefits of HMC include low setup costs for limited equipment, no requirement of highly trained expertise and in vitro effciency comparable to traditional somatic cell nuclear transfer technology. Embryos produced by HMC can be cryopreserved and capable of producing live births. The HMC technique is now applied to different species and can be used in large scale nuclear transfer programs.

Intraocular lens power calculation formulas in high refractive errors….what to choose and when.

Background & Objectives: Before performing the cataract surgery high level of expertise and knowledge is required to fulfil the ever increasing demands of patients. This makes a surgeon carry out detailed evaluation of a case and formulate a ‘customized IOL’. Accurate IOL power calculation is the most important part of planning a cataract surgery. Most of the formula works well with normal axial length, but with high refractive errors, there are many discrepancies for selection of IOL formula. Methods: Study included 80 high myopic eyes divided into three groups and 20 high hypermetropic eyes divided into two groups according to various A scan formulas utilised. Post-operative spherical equivalent in relation to various formulas for all groups compared. Results: Performance of all 3 formulas in high myopic group showed SRK/T formula to be most accurate with smallest Mean Absolute Error (MAE) in all axial length subcategories above 24mm, followed by Haigis, and Holladay I respectively. In high hypermetropic patients, among 2 formulas, the lowest MAE was found with Hoffer-Q (-0.03D) compared to SRK/T (-0.96D) Interpretation & Conclusion: Erroneous IOL power calculation can spoil high quality results expected by patients in terms of post-operative vision in spite of excellent surgery.

Complementary feeding practices in rural area of district Agra.

The study was conducted to assess the prevailing complementary feeding practices. Strikingly 30.9 percent infants were not receiving complementary foods. 21.9 percent mothers initiated complementary feeding at the right age. This was significantly associated with the literacy status of the mothers (p<0.05). 87.1 percent infants were receiving family pot feeding. The complementary foods fed to the infants were mostly (88.6%) of semi-solid consistency. Demand feeding was being practiced by 66.7 percent mothers. The practice of cleaning hands before feeding was very poor with only 17.1%. Thus to conclude the complementary feeding practices were not satisfactory in the rural area of Agra and need to be improved.

Genetic diversity and bottleneck studies in the Marwari horse breed.

Genetic diversity within the Marwari breed of horses was evaluated using 26 different microsatellite pairs with 48 DNA samples from unrelated horses. This molecular characterisation was undertaken to evaluate the problem of genetic bottlenecks also, if any, in this breed. The estimated mean (-/+ s.e.) allelic diversity was 5.9 (-/+ 2.24), with a total of 133 alleles. A high level of genetic variability within this breed was observed in terms of high values of mean (-/+ s.e.) effective number of alleles (3.3 -/+ 1.27), observed heterozygosity (0.5306 -/+ 0.22), expected Levene's heterozygosity (0.6612 -/+ 0.15), expected Nei's heterozygosity (0.6535 -/+ 0.14), and polymorphism information content (0.6120 -/+ 0.03). Low values of Wright's fixation index, F(IS) (0.2433 -/+ 0.05) indicated low levels of inbreeding. This basic study indicated the existence of substantial genetic diversity in the Marwari horse population. No significant genotypic linkage disequilibrium was detected across the population, suggesting no evidence of linkage between loci. A normal 'L' shaped distribution of mode-shift test, non-significant heterozygote excess on the basis of different models, as revealed from Sign, Standardized differences and Wilcoxon sign rank tests as well as non-significant M ratio value suggested that there was no recent bottleneck in the existing Marwari breed population, which is important information for equine breeders. This study also revealed that the Marwari breed can be differentiated from some other exotic breeds of horses on the basis of three microsatellite primers.

Oil massage in neonates: an open randomized controlled study of coconut versus mineral oil.

INTRODUCTION: Oil massage for newborns is reported to improve weight gain by better thermoregulation. A role for transcutaneous absorption has also been suggested. AIMS AND OBJECTIVES: This study was undertaken to compare the effect of massage with coconut oil versus mineral oil and placebo (powder) on growth velocity and neuro-behavior in well term and preterm babies. STUDY DESIGN: Open Randomized Controlled trial. SETTING: The Premature unit and the postnatal wards of a major teaching hospital in a metropolitan city. MATERIAL AND METHODS: Intramural preterm appropriate for gestational age babies weighing between 1500 to 2000 grams and term births weighing more than 2500 grams fulfilling the inclusion criteria constituted the two gestation age categories studied. Babies in each group were randomized to receive massage with either coconut oil, mineral oil or with placebo. Oil massage was given by a trained person from day 2 of life till discharge, and thereafter by the mother until 31 days of age, four times a day. Babies were followed up daily till discharge and every week after discharge for anthropometry. Neuro-behavioral outcome was assessed by the Brazelton Score at baseline, day 7 and on day 31. RESULTS: Coconut oil massage resulted in significantly greater weight gain velocity as compared to mineral oil and placebo in the preterm babies group; and in the term baby group, as compared to the placebo. Preterm infants receiving coconut oil massage also showed a greater length gain velocity compared to placebo group. No statistically significant difference was observed in the neurobehavioral assessment between all three subgroups in term babies as well as in preterm babies.

Increased capacitation of buffalo sperm by heparin as confirmed by electron microscopy and in vitro fertilization.

Capacitation of buffalo sperm was evaluated by induced acrosome reaction (AR) upon the exposure of 10 mM Ca2+. Culture of sperm for 8 hr in BO medium supplemented with 10 micrograms/ml heparin significantly (P < 0.01) increased the percentage of AR and confirmed by transmission electron microscopy. Vesiculization of outer acrosomal membrane and plasma membrane was observed significantly higher (P < 0.01) following 8 hr of sperm culture with heparin. Culture of sperm with heparin also increased rate of fertilization of in vitro matured oocytes and their subsequent development up to morula/blastocyst stage (P < 0.01). The study demonstrates that capacitation of buffalo sperm by heparin required at least 8 hr exposure of sperm to heparin for maximum acrosome reaction.

Overexpression of Escherichia coli single stranded DNA binding protein under bacteriophage T 7 promoter.

A recombinant vector for overproduction of the E. coli single stranded DNA binding protein (E. coli SSBP) has been constructed. An E. coli strain carrying this plasmid produces up to 150 mg pure SSBP per litre of bacterial culture in a laboratory shake flask. Electron microscopy of the single stranded DNA complexed with SSBP shows characteristic "beaded string"-like appearance. Strong clustering of protein molecules on ssDNA is indicative of a highly cooperative binding.

In vitro maturation and fertilization of goat oocytes.

Goat oocytes were isolated from 3-5 mm diam. follicles. The oocytes with compact cumulus mass were matured and fertilized in vitro. Three different media, viz. modified Krebs-Ringer bicarbonate, Dulbecco's and Ham's F-12 with three different additives (bovine serum albumin, BSA; follicle stimulating hormone, FSH and fetal calf serum, FCS) were tested. The three basal media gave almost similar results with Ham's F-12 being slightly better. Addition of BSA (10 mg/ml) increased the rates of maturation and penetration. FSH + BSA (2.5 micrograms/ml + 10 mg/ml) further enhanced the rates while FCS (10%) proved to be even more effective. In modified Krebs-Ringer bicarbonate and Dulbecco media with additives FCS + BSA, around 60% oocytes matured to metaphase II of which 53% were penetrated by capacitated goat spermatozoa while in F-12 medium 70% reached metaphase II and 63% were penetrated. Ham's F-12 medium with additives FCS + BSA was slightly better for maturation and penetration of goat oocytes in comparison to two other media tested.

Transfer RNA nucleoside composition in 13762 rat adenocarcinoma

Abnormalities in patterns of RNA methylation and in the activities of tRNA methyltransferases are well-documented phenomena. In this study, we focused our attention on tRNA from adenocarcinoma, a 9,10-dimethyl-1,2-benznthracene-induced mammary tumor, because prior evidence has suggested the occurence of an abnormal pattern of tRNA methylation. Chemical postlabeling of tumor vs normal rat liver and mammary gland tRNAs revealed tumor specific differences in the modified nucleoside distribution, i.e., a 5.8-fold increase in tumor n-2-methylguanosine together with a 2.7-,2.8-,2.6-, and 2.8-fold decrease in tumor 1-methyladenosine, dihydrouridine, pseudoridine and 5-methylcytidyne, respectively. Class A tRNAs, a slower gel migrating group of tumor tRNAs, exhibited even lower 1-methyladenosine levels. Most of the remaining nucleosides in class A tRNAs showed molar ratios similar to those found in bulk tumor tRNA. However, N-2-methylguanosine levels class A tRNA are intermediate between bulk tumor tRNA (2.8%) and mammary gland tRNA (0.49%). The only qualitative difference found in tumor tRNA seems to be the absence of inosine usually present in tRNAs from liver and mammary tissues. In spite of its abnormal methylation pattern adenocarcinoma tRNA binds to glucocorticoid receptor protein from mouse AtT-20 cells, generating a 65 tRNA-protein complex, in a fashion similar to that previously described for the endogenous tRNA isolated from the same cells

Enlarging pulmonary histoplasmoma associated with pulmonary tuberculosis.

Histoplasmosis is not a frequently reported infection from India. Similarity of its clinical and radiological features with pulmonary tuberculosis, may cause a difficult diagnostic dilemma when the two occur together. We report a case who initially presented with cavitary lesions over right lung responding well to anti tuberculosis chemotherapy but subsequently a small opacity present over the left upper zone showed a relentless increase till it attained a massive size few years later. Operative removal and histopathological examination of the mass confirmed it to be histoplasmoma. She became sputum AFB smear positive and culture negative for a short while during this period and this is explained on the basis of previous reports.

Effect of vitamin A deficiency on rat intestinal digestive & absorptive functions.

The effect of vitamin A deficiency on the intestinal absorption of nutrients and the activities of brush border enzymes were studied in albino rats. Intestinal uptakes of D-glucose, L-methionine, L-tryptophan and L-histidine were significantly greater in vitamin A-deficient animals than in controls. The specific activities of total adenosine triphosphatase (ATPase), ouabain-sensitive ATPase, maltase and sucrase in the intestinal mucosa of vitamin A-deprived rats were 121, 124, 131 and 134 per cent respectively, of the corresponding values in control animals. The DNA content of the small intestine in vitamin A-deficient rats was 36.5 per cent lower than in control rats. The stimulation in digestive and absorptive capacity appears to be an adaptive change in vitamin A-deficiency which decreases the intestinal cell population.

In vitro capacitation of goat spermatozoa.

Goat epididymal and ejaculated spermatozoa were incubated in Krebs-Ringer bicarbonate buffer containing pyruvate and lactate as energy source. A 3 hr incubation for epididymal and 4 hr for ejaculated spermatozoa was required for the capacitation and acrosome reaction to take place. Calcium is an essential requirement which was needed for motility maintenance/activation and for the initiation of acrosome reaction. A 2-fold increase in cAMP content was measured over 3 hr period of incubation of goat epididymal spermatozoa which was not seen when calcium ions were either omitted or chelated with EGTA. There is thus a definite involvement of Ca2+ ions and cAMP in capacitation and acrosome reaction of goat spermatozoa.

Necrobiotic pulmonary nodule leading to pyopneumothorax in a case of rheumatoid arthritis--a rare clinical presentation.

A 49-year-old male patient, an active case of sero positive rheumatoid arthritis involving multiple joints with bilateral necrobiotic pulmonary nodules is presented. Initial symptoms were of progressively increasing dyspnoea. The nodule in the right lung subsequently cavitated leading to pyopneumothorax. The diagnosis of rheumatoid lung was confirmed by post-mortem.