Simulation training to improve aseptic non-touch technique and success during intravenous cannulation-effect on hospital-acquired blood stream infection and knowledge retention after 6 months: The snowball effect theory.

BACKGROUND: Intravenous cannulation is a common procedure and a valuable skill in the neonatal intensive care unit. Standardized procedure and personnel training are needed in the unit to prevent hospital-acquired blood stream infections. Hence, we evaluated the effect of training using a low-fidelity simulation on the improvement of the aseptic non-touch technique during intravenous cannulation and knowledge retention after 6 months. METHODS: The study was conducted in a tertiary care neonatal unit from June 2017 to July 2018. All the staff nurses and junior resident doctors posted in the neonatal intensive care were included in the study. A protocol and checklist score sheet was developed. The score sheet consisted of 23 items with a total score of 46. Participants were expected to obtain a minimum of 80%. A pre-test was conducted initially, followed by a formal training and then a post-test. The NITA newborn venous access mannequin was used to facilitate the training. A re-training for new nurses was conducted after 6 months. Data were analyzed using paired t-test. RESULTS: A total of 29 doctors and nurses were enrolled in the training. The mean pre-test score was 29.93 compared to 42.66 in the post-test scores (mean difference 12.24(95% confidence interval: 9.39-16.05), p < 0.01. The mean scores were higher when the simulation was conducted after 6 months. There was a significant decline in blood stream infection rates from 5.5 to 1.65 per 1000 patient days (p = 0.05). CONCLUSION: Simulation-based training of health care personnel is a good modality to improve aseptic non-touch technique during intravenous cannulation in the neonatal intensive care unit. Simulation-based training also helps in knowledge retention and standardization of training procedures.

Response Measures to Infection Outbreaks During the Second Year of Sustenance Phase of Infection Control Quality Improvement.

OBJECTIVE: To analyze the infection outbreaks, control measures and outcomes of the outbreak in the NICU of a tertiary care centre in the year 2018. METHODS: This study was conducted in a 30 bedded tertiary care NICU from January 2018 through December 2018. The study design was an Outbreak investigation, based on a program of prospective surveillance for nosocomial infection. All neonates admitted to the NICU formed part of the the study. An Infection Control Quality Improvement (QI) team was available to analyze the infection and initiate response action to outbreaks. RESULTS: Three outbreaks were reported in the year 2018. The first was in May 2018 and comprised of colonization with rectal Multi-drug resistant gram negative bacilli (MDR GNB). The outbreak was controlled by using Aseptic non-touch technique (ANTT) for fortification of milk and using distilled water for cleaning of diaper area. The second outbreak in August 2018 was Methicillin resistant Staphylococcus aureus (MRSA) whose source was a maternal Lower segment cesarean section (LSCS) wound. The third outbreak in October 2018 was MDR Acinetobacter. The source was from an outborn having the same organism. All infants were in close proximity to the index case. This outbreak was controlled with cohorting, hand hygiene and strengthening of bundle care. CONCLUSIONS: Surveillance aids in early detection and successful control of outbreaks. A systematic search for the source and meticulous containment of spread can successfully control an outbreak.

Evaluation of HCP5 and Chemokine C Receptor type 5 Gene Polymorphisms in Indian Psoriatic Patients.

BACKGROUND: Genetic variations associated with nonprogression of HIV infection to AIDS are enriched in psoriasis patients. HCP5 gene 335 T > G and chemokine C receptor type 5 (CCR5) gene Δ32 polymorphisms are associated with HIV nonprogression phenotype. AIM: The aim of this study was to determine the association of HCP5 gene 335 T > G (rs2395029) and CCR5 gene Δ32 (rs333) polymorphisms with psoriasis vulgaris (PV). MATERIALS AND METHODS: Genotype of HCP5 gene 335 T > G and CCR5 gene Δ32 polymorphisms were determined by polymerase chain reaction (PCR)-restriction fragment length polymorphism and allele-specific PCR methods, respectively. RESULTS: The frequency of HCP5 gene 335 T > G SNP was ~7 times higher in PV patients than in the control group (P = 1.49 × 10-8; odds ratio [OR] = 10.2; 0.95 confidence interval [CI]: 3.9-26.8). OR for the occurrence of HCP5 335 G allele in either homozygous or heterozygous genotype in PV patients was 13.1 (0.95 CI: 4.7-36.1). The strength of association was higher with moderate-to-severe subgroup (P = 3.29 × 10-9; OR = 18.4; 0.95 CI: 6.2-54.9) than with mild subgroup (P = 2.1 × 10-4; OR = 8.3; 0.95 CI: 2.6-23.3). In addition, the strength of association was higher with Type I (P = 9.53 × 10-8; OR = 15.3; 0.95 CI: 5.1-46.5) than with Type II subgroup (P = 6.8 × 10-6; OR = 11.0; 0.95 CI: 3.6-33.9). Type I gene Δ32 polymorphism was observed neither among psoriatic nor among healthy individuals. CONCLUSIONS: Our results indicate that HCP5 gene 335 T > G polymorphism and not CCR5 gene Δ32 polymorphism is associated with the increased risk of developing PV.

Novel association of oral squamous cell carcinoma with GSTP1 Arg187Trp gene polymorphism.

AIMS: Glutathione S-transferase subtype pi 1 (GSTP1) is an enzyme that is involved in the detoxification of carcinogenic substances. Arg187Trp is a functional polymorphism in the corresponding GSTP1 gene that reduces the enzymatic activity by 45%. We evaluated, for the first time, the association of Arg187Trp with the risk of oral squamous cell carcinoma and compared it with other established GSTP1 polymorphisms viz, Ile105Val and Ala114Val. MATERIALS AND METHODS: We carried out a 1:2 case-control study by recruiting 100 patients with oral squamous cell carcinoma and 200 age and gender-matched healthy individuals. Ile105Val, Ala114Val, and Arg187Trp polymorphisms were genotyped by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and their distribution in the study groups was compared by chi-squared test (Fisher's exact). RESULTS: The minor allele of Ala114Val and Arg187Trp were more common in patients than in controls. In contrast, the distribution of Ile105Val minor allele was similar in the two groups. The differential distribution was also significant at the level of genotypes. CONCLUSIONS: These results indicate that GSTP1 Arg187Trp is associated with the risk of developing oral squamous cell carcinoma. Our study underlines the importance of detoxification pathway in the risk of carcinogenesis.

Atrial fibrillation associated genetic variation near PITX2 gene increases the risk of preeclampsia.

OBJECTIVES: SNP rs2200733 located near PITX2 gene is associated with the risk of atrial fibrillation. Preeclamptic women are at increased risk of developing cardiovascular disease like atrial fibrillation. Whether this translates into an association between SNP rs2200733 and preeclampsia is not known. Therefore, we determined the association of SNP rs2200733 (C/T) with the risk of preeclampsia. STUDY DESIGN: A hospital based prospective case-control study involving 585 pregnant women of whom 285 were preeclamptic and 300 were normotensive. SNP rs2200733 was genotyped by PCR-RFLP method. MAIN OUTCOME MEASURES: Statistical significance of the difference in the minor allele frequency between case and control groups was determined by Fisher's exact test. RESULTS: Minor allele frequency was 21.4% among preeclamptic pregnant women and 13.7% among normotensive pregnant women (P = 0.00064; odds ratio = 1.72 (0.95 CI: 1.23-2.41). The measures of association were heterogeneous when compared after categorisation of the preeclamptic group into clinical sub-groups. The association was not significant with the eclampsia sub-group (P = 0.39) but relatively higher with the sub-group not superimposed by eclampsia (P = 0.0000048; odds ratio = 2.10 [0.95CI: 1.50-2.92]). Furthermore, the association was relatively higher with the sub-group involving intrauterine growth retardation and intrauterine death (P = 0.00017; odds ratio = 2.89 (0.95CI: 1.65-4.94)]. CONCLUSIONS: Minor allele of SNP rs2200733 is associated with the risk of preeclampsia. SNP rs220073 may represent a common risk factor that predispose women to develop both preeclampsia during pregnancy and cardiovascular disease later on.

GSTP1 c.341C>T gene polymorphism increases the risk of oral squamous cell carcinoma.

Glutathione S Transferases (GST) are anti-oxidant enzymes involved in detoxification of cellular and exogenous carcinogens and oxidative products of reactive oxygen species. Genetic polymorphisms can attenuate the detoxification capacity of GST and consequently increase the susceptibility to carcinogenesis. There are eight classes of GST enzymes of which pi subtype is the predominant form expressed in the oral mucosa. c.341C > T single nucleotide polymorphism (rs1138272) in GSTP1 gene, is a functional variation that reduces the enzymatic activity of GST pi. We carried out a 1:2 case-control study involving 270 individuals to determine the association of c.341C > T variation with the risk of oral squamous cell carcinoma. GSTP1 c.341C > T variation was genotyped by PCR-RFLP method. GST pi expression in the tumour sample was determined by immunohistochemistry. Tobacco consumption was the major risk factor among cancer patients. The odds ratio for the risk of oral squamous cell carcinoma in individuals with the minor allele was 4.5 (0.95 CI = 2.3-8.9; P = 0.000004). The genotype was found to follow dominant mode of inheritance (OR 4.4 [0.95 CI = 2.1-9.2]; P = 0.00006). Our results support the conclusion that c.341C > T variation in GSTP1 increases the risk of OSCC in patients habituated to tobacco consumption.

Nicotinic acetylcholine receptor gene polymorphism is not associated with tobacco-related oral squamous cell carcinoma.

BACKGROUND: Nicotinic acetylcholine receptor is implicated in carcinogenesis indirectly through increasing nicotine dependence and directly through its impact on cell-cycle regulation. Functional polymorphism in nicotinic acetylcholine receptor alpha-5 subunit gene (CHRNA5 c.1192G>A; rs16969968) is associated with nicotine dependence and risk of lung cancer. AIM: The aim of this study was to evaluate the association of CHRNA5 c.1192G>A polymorphism with the risk of oral squamous cell carcinoma (OSCC). SETTINGS AND DESIGN: This was a rural teaching hospital-based case-control study. MATERIALS AND METHODS: A total of 100 histopathologically confirmed cases of OSCC patients and 100 age- and gender-matched healthy individuals were genotyped for CHRNA5 c.1192G>A polymorphism by polymerase chain reaction-restriction fragment length polymorphism method. Allele and genotype frequencies among case and control groups were compared by Chi-squared test (Fisher's exact). RESULTS: The frequency of CHRNA5 c.1192A allele was 22% in OSCC patients and 26% in control individuals. The difference in the distribution of alleles and genotypes between case and control groups was not significant (P > 0.05). CONCLUSIONS: CHRNA5 c.1192G>A polymorphism is not associated with the risk of developing OSCC.

Profile of Tumour Necrosis Factor Alpha -308 G/A Gene Polymorphism in Psoriatic Patients in Karnataka, India.

INTRODUCTION: Tumour necrosis factor-alpha (TNFα) gene -308G/A polymorphism (rs1800629) are associated with psoriasis in several populations worldwide. Presently, there is no literature on the status of this polymorphism in the South Indian population. AIM: To determine the profile of TNFα -308G/A polymorphism among psoriatic patients. MATERIALS AND METHODS: This case-control study involved 74 patients with Psoriasis Vulgaris (PsV) and 74 age and gender matched healthy individuals. Patients were recruited from the Department of Dermatology of R.L. Jalappa Hospital and Research Center, Tamaka, Kolar, Karnataka, India, from March 2014 to March 2016. TNFα -308G/A polymorphism was genotyped by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method. RESULTS: The frequency of TNFα -308A allele 7.4% among psoriatic and 8.8% among non-psoriatic individuals. The difference was not statistically significant (p=0.82). CONCLUSION: Our results indicate that TNFα gene -308G/A polymorphism is not a significant marker for the risk of developing PsV among South Indian (Karnataka) psoriatic patients.

Tumor necrosis factor alpha gene promoter -238G/A polymorphism increases the risk of psoriasis vulgaris in Indian patients.

BACKGROUND: Tumor necrosis factor alpha (TNFα) gene -238G/A polymorphism (rs361525) is associated with psoriasis in several populations worldwide. To the best of our knowledge, there is no information about this polymorphism in Indian psoriatic patients. This study was undertaken to fill the gap in knowledge. METHODS: This case-control study involved 72 patients with psoriasis vulgaris (PsV) and 72 age and gender matched healthy individuals. TNFα -238G/A polymorphism was genotyped by PCR-RFLP method. RESULTS: TNFα -238A allele was 5 times commoner in PsV patients than in the control group (P = 4.1 × 10-7 ; odds ratio [OR] = 6.5 [0.95 CI: 2.9-14.6]). Distribution of the genotypes in the two groups showed statistically significant difference in dominant genetic model (P = 2.3 × 10-7 ) and not in recessive genetic model (P = 2.5 × 10-1 ). Odds ratio for the occurrence of -238A genotype in PsV patients was 8.8 (0.95 CI: 3.5-20.2). The association showed no major difference when PsV patients were subgrouped into type I and type II categories and tested separately. Subgroup analysis on the basis of disease severity showed higher association with the moderate-severe subgroup (P = 2.4 × 10-9 , OR 15.4 [0.95 CI: 5.8-41.0]) than with mild subgroup (P = 1.3 × 10-2 , OR 3.8 [0.95 CI: 1.3-10.9]). CONCLUSIONS: Our results indicate that TNFα gene -238G/A polymorphism increases the risk of developing psoriasis vulgaris among Indians. Also, the data show that severity and not the type affects the strength of association in this population.

Prevalence of human papillomavirus in oral squamous cell carcinoma: A rural teaching hospital-based cross-sectional study.

BACKGROUND: Human papillomavirus (HPV) is a well-established oncogenic agent in the pathogenesis of cervical carcinoma. Its role in the oncogenesis of tumors such as oral squamous cell carcinoma (OSCC) is not clear. Globally, approximately 3% of OSCCs are positive for HPV. Studies conducted in India indicate its prevalence from as low as 0% to as high as 74%. However, a recent Indian study on leukoplakia failed to find any evidence of HPV involvement. This motivated us to reexamine the HPV status in OSCC. AIM: To evaluate the prevalence of HPV in OSCC. SETTINGS AND DESIGN: This was a rural teaching hospital-based cross-sectional study. SUBJECTS AND METHODS: Sixty histopathologically confirmed samples of OSCC were used for the study. Genomic DNA was isolated from frozen, surgically-resected specimens. HPV positivity was tested by polymerase chain reaction-based method using GP5+/6+ primers in the L1 consensus region of the viral genome. RESULTS: None of the samples were HPV positive. CONCLUSIONS: Results of this study indicate that the association between HPV and OSCC may be overestimated. Hence, multicentric studies covering diverse geographical and socioeconomic groups are needed to delineate the profile of HPV infectivity and OSCC in the Indian subcontinent.