Point prevalence & risk factor assessment for hospital-acquired infections in a tertiary care hospital in Pune, India.

BACKGROUND & OBJECTIVES: Hospital-acquired infections (HAIs) are a major challenge to patient safety and have serious public health implications by changing the quality of life of patients and sometimes causing disability or even death. The true burden of HAI remains unknown, particularly in developing countries. The objective of this study was to estimate point prevalence of HAI and study the associated risk factors in a tertiary care hospital in Pune, India. METHODS: A series of four cross-sectional point prevalence surveys were carried out between March and August 2014. Data of each patient admitted were collected using a structured data entry form. Centers for Disease Control and Prevention guidelines were used to identify and diagnose patients with HAI. RESULTS: Overall prevalence of HAI was 3.76 per cent. Surgical Intensive Care Unit (ICU) (25%), medical ICU (20%), burns ward (20%) and paediatric ward (12.17%) were identified to have significant association with HAI. Prolonged hospital stay [odds ratio (OR=2.81), mechanical ventilation (OR=18.57), use of urinary catheter (OR=7.89) and exposure to central air-conditioning (OR=8.59) had higher odds of acquiring HAI (P<0.05). INTERPRETATION & CONCLUSIONS: HAI prevalence showed a progressive reduction over successive rounds of survey. Conscious effort needs to be taken by all concerned to reduce the duration of hospital stay. Use of medical devices should be minimized and used judiciously. Healthcare infection control should be a priority of every healthcare provider. Such surveys should be done in different healthcare settings to plan a response to reducing HAI.

Amoeboma-lest we forget!!!

Amoebiasis is an infection with the parasitic intestinal protozoan Entamoeba histolytica (E. histolytica). Most infections are usually asymptomatic, but the disease spectrum can range from dysentery to extraintestinal infections, including liver abscesses. The management of a 68-year-old male with amoeboma, a rare manifestation of intestinal amoebiasis, is described along with a review of literature.

Antimicrobial use and antimicrobial resistance in nosocomial pathogens at a tertiary care hospital in Pune.

BACKGROUND: Resistance to antimicrobial agents is emerging in wide variety of nosocomial and community acquired pathogens. Widespread and often inappropriate use of broad spectrum antimicrobial agents is recognized as a significant contributing factor to the development and spread of bacterial resistance. This study was conducted to gain insight into the prevalent antimicrobial prescribing practices, and antimicrobial resistance pattern in nosocomial pathogens at a tertiary care hospital in Pune, India. METHODS: Series of one day cross sectional point prevalence surveys were carried out on four days between March and August 2014. All eligible in patients were included in the study. A structured data entry form was used to collect the data for each patient. Relevant samples were collected for microbiological examination from all the clinically identified hospital acquired infection cases. RESULTS: 41.73% of the eligible patients (95% CI: 39.52-43.97) had been prescribed at least one antimicrobial during their stay in the hospital. Beta-lactams (38%) were the most prescribed antimicrobials, followed by Protein synthesis inhibitors (24%). Majority of the organisms isolated from Hospital acquired infection (HAI cases) were found to be resistant to the commonly used antimicrobials viz: Cefotaxime, Ceftriaxone, Amikacin, Gentamicin and Monobactams. CONCLUSION: There is need to have regular antimicrobial susceptibility surveillance and dissemination of this information to the clinicians. In addition, emphasis on the rational use of antimicrobials, antimicrobial rotation and strict adherence to the standard treatment guidelines is very essential.

Stapled hemorrhoidopexy - Initial experience from a general surgery center.

BACKGROUND: Stapled hemorrhoidopexy is gaining popularity as a relatively painless alternative to conventional excisional hemorrhoidectomy. The initial experience from a service hospital is presented along with review of literature. METHODS: 40 cases were managed by stapled hemorrhoidopexy (SH) over a period of two and half years. The primary outcome measures assessed were the analgesic requirement in the post-operative period and the time taken to resume Activities of Daily Living (ADL). Additional outcome measures studied were; presence of bleeding per rectum, prolapse of mass per rectum, incontinence to flatus/stool, post-operative urinary retention, requirement of a repeat procedure, presence of post-operative anal stenosis, and residual external haemorrhoids at 1 week, 1, 3 and 6 months and 1 year after surgery. RESULTS: 40 patients with grade II, III and IV hemorrhoids underwent SH under spinal anesthesia. In the first 24 h 17 patients required a single dose of Injection Diclofenac Sodium while 19 patients required two doses and 4 patients had to be given three doses. 14 patients (35%) achieved Katz Index of Independence in Activities of Daily Living score of 6 on the first post-operative day and another 17 (42.5%) on the second post-operative day. By the fourth post-operative day all patients had achieved a score of 6. One patient had a rectal perforation as a complication of the procedure and another required a second procedure for excision of thrombosed external hemorrhoids. CONCLUSION: Stapled hemorrhoidopexy is associated with less post-operative pain and early resumption of ADL. Although the procedure appears simple to perform, it can be associated with serious complications and still cannot be considered the standard of care for the operative treatment of internal hemorrhoids.

Profile of malignancies at Medical College, Ambajogai--(15 years retrospective study).

Present study comprises of a preliminary analysis of malignant lesions, diagnosed and confirmed by histopathological examination, carried out in Department of Pathology, S. R. T. R. Medical College, Ambajogai, from August 1976 to July 1991. 30,168 specimens were received for histopathological examination out of which 2,663 cases were diagnosed as malignant lesions (8.82%). 163 cases of leukemias were diagnosed by peripheral smear and bone marrow examination. Our of 2826 patients with malignant lesions 1,566 (55.41%) were males and 1,260 (44.59%) were females with M:F ratio as 1.24:1. Analysis of all malignant lesions showed more predilection towards genital organs (26.22%), gastrointestinal tract (13.72%) and breast (10.47%). Penis (11.36%), gastrointestinal tract (16.73%), oral cavity and tongue with pharynx (20.81%) and skin (11.11%) were leading sites in males where as cervix (30.63%) breast (22.46%), gastrointestinal tract (10.00%), skin (6.82%) and lymphoma, leukaemias (7.30%) were common sites for malignancies in females. The higher incidence of genital and skin tumours is discussed in the paper. Available data is compared with data from Tata Memorial Cancer Hospital Bombay and Cancer Hospital at Barshi in Solapur District of Maharashtra.