Microbiological profile of lower respiratory tract infections in neurological intensive care unit of a tertiary care center from Central India.

BACKGROUND: Lower respiratory tract infections (LRTI's) are the most frequent infections among patients in intensive care units. The consequences of increased drug resistance are far reaching since bacterial infection of the lower respiratory tract (LRT) is a major cause of death from infectious disease. OBJECTIVE: The study was conducted with the aim of determining the bacterial etiology of LRTI in the neuro intensive care unit (NICU) as well as to update the clinicians with the various antimicrobial alternatives available in the treatment of LRTI. SUBJECTS AND METHODS: The study was conducted for the period of 3 years from January 2010 to December 2012 in the Microbiology Department of a Teaching Tertiary Care Hospital. The LRT specimens from 230 patients admitted in a NICU during the study period were processed. Following culture, the isolated organisms were identified and antimicrobial sensitivity was performed by standard methods. RESULTS: Out of the 230 LRT specimens evaluated, 198 (86.08%) were culture positive. A total of 254 pathogens were recovered with a predominance of Gram-negative isolates (n = 243; 96.05%) Pseudomonas aeruginosa was the most dominant pathogen followed by Klebsiella pneumoniae. Alarmingly high percentage of extended spectrum beta-lactamase and methicillin resistant Staphylococcus aureus isolates were detected. The resistance to cephalosporins, aminoglycosides and carbapenem were remarkable. CONCLUSIONS: Therefore, we can conclude that for effective management of LRTI's, an ultimate and detailed bacteriological diagnosis and susceptible testing is required to overcome global problem of antibiotic resistance.

Investigating the effect of CoCl2 administration on diabetic nephropathy and associated aortic dysfunction.

AIM: Endothelial dysfunction appears to be a consistent finding in diabetic nephropathy. The study aimed to investigate the effect of cobalt chloride in the amelioration of endothelial dysfunction in uninephrectomized diabetic rats. METHODS: We examined the effect of CoCl(2) (10 mg/kg, i.p., OD = once a day) treatment on contractile responses to angiotensin II (10(-10) to 10(-6)M) in an aortic preparation of control rats and uninephrectomized diabetic control rats. Blood glucose, plasma urea, creatinine, uric acid, aortic endothelial nitric oxide synthase (eNOS), nitrate/nitrite (NOx), superoxide dismutase, catalase and reduced glutathione levels were checked in the different groups. RESULTS: A significant attenuation of the augmented responses to angiotensin II was observed in CoCl(2)-treated animals along with a fall in plasma urea, creatinine and uric acid levels. A significant reduction in blood glucose and an increase in aortic eNOS and NOx levels along with antioxidants levels were observed. CONCLUSION: Chronic hypoxia augments angiotensin II responses in the thoracic aorta of uninephrectomized diabetic control rats. CoCl(2) attenuates these enhanced vascular responses with a significant decrease in blood glucose signifying stabilization of the hypoxia-inducible factor in the alleviation of endothelial dysfunction in diabetic nephropathy.

Comparative Study of Intra-cervical Foley's Catheter and PGE(2) Gel for Pre-induction Ripening (Cervical).

AIM: The success of induction of labor depends on the cervical status at the time of induction. OBJECTIVE: For effective cervical ripening both Foley's catheter and PGE(2) gel are used. The aim of this study was to compare the efficacy of intra cervical Foley's catheter and intra cervical PGE(2) gel in cervical ripening for the successful induction of labor. STUDY DESIGN: A randomized, prospective study was conducted in the Dept of OBGY, GMCH, Aurangabad from July 2005-January 2008. 400 patients at term with a Bishop's score ≤3 with various indications for induction were randomly allocated to receive (200 pts) intra-cervical Foley's catheter or PGE(2) gel (200 pts). After 6 h post induction, Bishop's score was noted labor was augmented if required. Statistical analysis was done using Chi square test and t test. RESULT: The groups were comparable with respect to maternal age, gestation age, indication of induction and initial Bishop's score. Both the groups showed significant change in the Bishop's score, 5.56 ± 1.89 and 5.49 ± 1.82 for Foley's catheter and PGE(2) gel, respectively, P < 0.001; However there was no significant difference between the two groups. There was no significant difference in the side effects. Twenty eight cesarean sections (14%) were performed in Group A and 37 (18.5%) were performed in Group B (not significant). The induction to delivery interval was 15.32 ± 5.24 h in Group A and 14.2 ± 5.14 h in Group B (P = 0.291). Apgar scores, birth weights and NICU admissions showed no difference between the two groups. CONCLUSION: This study shows that both Foley's Catheter and PGE(2) gel are equally effective in pre induction cervical ripening.

Bacteriological and mycological study of corneal ulcers in and around Aurangabad.

In the present study an attempt was made to find out bacteria and fungi causing corneal ulcers. Sixty cases of corneal ulcer were studied. Corneal scrapings from patient of corneal ulcer were collected and processed for isolation of bacterial and fungal agents. The commonest age group affected was 21-30 yrs. Incidence of corneal ulcer was more in males 39 (65%) as compared to females 21 (35%). Trauma was the commonest predisposing factor. Out of sixty cases of corneal ulcer positive cultures were obtained in 23 (38.33%). Bacteria were isolated in 10 (16.66%) fungi in 12 (20%) and mixed culture in 1 (1.66%) of the patients. Among the bacterial isolates commonest was Staphylococcus aureus 6 (10%). Among fungal isolates Fusarium species was the commonest isolate 4 (6.66).

Epidemiology of cholera--a five year study.

A total of 286 strains of Vibro Cholerae were isolated and tested over a period of five years. The strains were identified by standard methods and confirmed by slide agglutination tests with polyvalent, Ogawa and Inaba antisera. The non-agglutinating strains were tested with O-139 antisera. The maximum number of cases were found in the age group of 0-10 years. The number of females affected was more than the males. V. cholerae O-139 was isolated in the year 1998 and then again in 2000. V. cholerae serotype Inaba was found only in the year 1999. All of the other isolates belonged to the serotype Ogawa. The periodic shift between O1 and O-139 serogoups is reminiscent of the shifts from the Ogawa to the Inaba serotypes periodically witnessed among V. cholerae, possibly mediated by the immune pressure in the population.

Prevalence of resistant Staphylococcus aureus at Aurangabad.

Seven hundred and eighty three isolates of Staphylococcus aureus isolated from pus (586), blood (78), sputum (25), urine (23), cerebrospinal fluid (23) and various other body fluids (48) were subjected to in-vitro antimicrobial susceptibility testing by modified Kirby-Bauer method. Almost all the isolates were resistant to penicillin (99.62 per cent) and ampicillin (99.62 per cent). Resistance to erythromycin, tetracycline and cotrimoxazole was observed in 88.5, 87.62, and 80.85 per cent isolates respectively. Resistance to gentamicin was 68.32 per cent. Resistance to most of the commonly used antimicrobial agents indicates a need to replace these drugs with other agents and maintenance of surveillance to detect changing patterns of resistance.

Changing aetiology of urinary tract infections and emergence of drug resistance as a major problem.

A study was undertaken to ascertain the spectrum of causative agents responsible for UTI and to detect the magnitude of anti microbial resistance in aetiological agents. Klebsiella species caused urinary tract infection in maximum number of cases (124, 37.35%) followed by Escherichia coli (114, 34.4%), Pseudomonas aeruginosa 32 (9.64%) and Staphylococcus aureus 23 (6.93%). Other organisms caused urinary tract infection in 39 (11.75%) cases. Resistance to gentamicin was observed in 83% S. aureus, 84.7% Klebsiella species, 78.1% Escherichia coli, 71.9% Pseudomonas aeruginosa and 94.8% of remaining isolates. A large number of isolates (> 90%) were resistant to ampicillin, Cotrimoxazole erythromycin, and chloramphenicol. All the isolates of S.aureus were resistant to penicillin. This observations indicate extremely high degree of resistance in urinary pathogen and warrant change in antibiotic usage as well as formulation of policy for rational use of antibiotics.

Erythrocyte vitamin B12 activity in lactovegetarian pregnant Indian women.

Plasma and erythrocyte vitamin B12 levels were studied in pregnant Indian women consuming very little food of animal origin and compared with healthy non-pregnant women from the same dietetic group. The comparison of the mean values for routine haematological parameters revealed distinct fall in haemoglobin, packed cell volume, plasma vitamin B12, and albumin levels in pregnant women. However, the mean erythrocyte vitamin B12 levels in pregnant women with haemoglobin of more than 10 g/dl did not differ significantly from the corresponding mean observed in non-pregnant subjects. It seems that in normal pregnancy, the fall in erythrocyte vitamin B12 is much less marked than the fall in plasma levels of this vitamin.

Vitamin B12 and vegetarianism in india.

Apparently healthy Indian lactovegetarians have significantly lower serum levels and urinary excretion of vitamin B12 as compared to non-vegetarians. The low levels of serum vitamin B12 in lactovegetarians are not due to defective absorption but to low dietary intake of this vitamin. Inspite of considerably low serum vitamin B12 values, the lactovegetarians have no apparent signs or symptoms of vitamin B12 deficiency and their response to injected cyanocobalamin mixed with tracer radioactive B12, as judged by urinary excretion pattern and liver uptake, was similar to that observed in nonvegetarians.