A Retrospective Study on UTI by Myroides Species: An Emerging Drug Resistant Nosocomial Pathogen.

Aim and background: Myroides (M.) species are ubiquitous in the environment and cause a variety of infections like urinary tract infections (UTI), sepsis, meningitis, cholecystitis, pneumonia, and soft tissue infections, especially among immunocompromised populations. These are usually resistant to multiple antibiotics. This study aimed to demonstrate the clinical profile, underlying comorbidities, and antimicrobial susceptibility of Myroides isolates obtained from nosocomial UTI cases. Materials and methods: A sudden rise in the isolation of Myroides spp. from the repeated urine samples of admitted patients alerted us to conduct this retrospective observational study. Urine cultures that grew M. species were included in this study. Antibiotic susceptibility was performed and the patient's clinical data was analyzed. Results: A total of 14 Myroides spp. isolates were obtained from urine culture. The maximum number of cases (71.4%) were from the Nephrology ward and ICUs. The average (mean) age of patients was 46 years (range 2-80 years). All patients were catheterized. All isolates were multidrug resistant. Minocycline and doxycycline were the only drugs found effective in this study. Conclusions: Myroides species are emerging rare pathogens that can cause UTI in immunocompromised and catheterized patients. Minocycline may be used for treating such infections. How to cite this article: Sahu C, Chaudhary R, Bhartiya C, Patel SS, Bhatnagar N. A Retrospective Study on UTI by Myroides Species: An Emerging Drug Resistant Nosocomial Pathogen. Indian J Crit Care Med 2024;28(4):399-403.

A Retrospective Analysis of High Resolution Ultrasound Evaluation of the "Split Fat Sign" in Peripheral Nerve Sheath Tumors.

Peripheral nerve sheath tumors (PNST) comprise schwannomas and neurofibromas. The finding of increased adipose tissue around benign PNSTs has been described as the "split fat sign" on magnetic resonance imaging exams, which is suggestive of an intramuscular or intermuscular location of the tumor. However, few studies have described this sign as a salient ultrasound feature of PNSTs. The main purpose of this study was to retrospectively evaluate the presence of increased fatty tissue deposition around benign PNSTs diagnosed by high-resolution ultrasound. In addition, we aimed to corroborate the presence of vascularization around the affected area. A retrospective analysis of ten cases of PNSTs and two cases of post-traumatic neuromas diagnosed by high-resolution ultrasound was performed with a Logiq® P8 ultrasound with a 2-11 MHz multifrequency linear probe L3-12-D (central frequency: 10 MHz). Localized types of neurofibromas and schwannomas in any location were seen as predominantly hypoechoic tumors with an oval or fusiform shape. Exiting and entering nerves (tail sign) were observed in six cases, showing localized lesions both in intermuscular and subcutaneous locations. The presence of increased hyperechoic tissue (the split fat sign) was noted in cases of solitary intermuscular and intramuscular peripheral nerve sheath tumors, mainly the schwannomas. Though small tumors did not demonstrate the tail sign, the increase in adipose tissue and vascularity on US was well demonstrated. In conclusion, the nerve in continuity forms the basis of the ultrasonographic diagnosis of PNSTs. However, high-resolution US can convincingly demonstrate the increased presence of fat in the upper and lower poles as well as circumferentially in intermuscular or intramuscular benign PNSTs.

Altered color of plasma component - Unnecessary wastage of a precious resource.

BACKGROUND AND OBJECTIVES: The present study was conducted to evaluate the etiology of altered color of plasma component of blood in transfusion practice. MATERIALS AND METHODS: The study was conducted at the blood center of a tertiary care teaching hospital in western India for a period of 6 months. After component separation, all the plasma units with altered color were segregated and samples were taken for further evaluation. Altered colored plasma units were divided into three - green discoloration, yellow discoloration, and lipemic plasma. Donors were called, their detailed history was taken, and necessary investigations were done accordingly. RESULTS: Forty plasma units out of 20,658 (0.19%) donations showed discoloration. Out of which, 3 plasma units showed green discoloration, 9 plasma units showed yellow discoloration, and the remaining 28 plasma units were lipemic. Among three donors whose plasma showed green discoloration, one female donor had a history of oral contraceptive pill usage and had higher values of copper and ceruloplasmin. All donors with yellow plasma had a higher value of unconjugated bilirubin. All the donors with lipemic plasma gave a history of intake of fatty meal prior to donating blood and showed higher values of triglyceride, cholesterol, and very-low-density lipoprotein. CONCLUSION: Plasma component with altered color restricts its issue to the patient and also for use in fractionation. In our study, many of the altered color plasma units were safe to transfuse, but the decision regarding transfusion was debatable on consultation with the treating doctor. Further studies with a large sample size are recommended for the use of these plasma components.

Spectrum of Hand Arthritis: Doppler Ultrasound, Diffusion-Weighted MR Imaging, and Perfusion MR Imaging Evaluation.

Early diagnosis of arthritis is of paramount importance to slow the progression of disease and joint destruction. Because of temporal dissemination of the clinical and laboratory manifestations of the inflammatory arthritis and overlap of the findings, diagnosis can be challenging in early stages of the disease. This article highlights the utility of advanced cross-sectional imaging, including color-Doppler ultrasound, diffusion-weighted MR imaging, and perfusion MR imaging in the domain of arthropathy so that the reader can apply these principles and techniques in their practices for timely and accurate diagnosis and improved multidisciplinary communications for better management of such conditions.

Myxolipoma of hand in a child: case report of a rare tumor.

Lipomatous tumors account for less than 10% of tumors in the pediatric population. Myxolipomas (a subset of lipoma characterised by mature adipose tissue and abundant mucoid substance) are found to be even rarer. There are a few case reports in different body parts like heart, kidney, oral cavity, epiglottis, cervical and mediastinal regions. However, there are no case reports on the involvement of the hands in any age group. High resolution ultrasound is the imaging modality of choice for the initial evaluation of superficial soft tissue tumors, their site, nature and extent. In conjunction with clinical findings and age of presentation, it helps in narrowing down the differential diagnosis and planning the management. Hyperechoic fatty tumors in the pediatric hand are mostly benign and includes lipomas, lipoblastomas and fibrous hamartomas of infancy as the main differentials. A definitive diagnosis is based on a histo-pathological and molecular cytogenetic examination. This article presents a never before reported case of a rare, large, myxolipoma of the hand in a 22-month-old boy.

Maternal allo anti-M antibody-induced hemolytic disease of newborn.

Hemolytic disease of the fetus and newborn is a syndrome associated with immune destruction of the fetal and newborn red cells by maternal red cell alloantibodies. The detection of anti-M in antenatal screening can be responsible for neonatal red cell aplasia. A 32-h-old full-term neonate admitted with inconsolable cry and mild fever. Laboratory tests revealed progressive anemia and hyperbilirubinemia on day 3. The peripheral blood smear showed evidence of hemolysis and reticulocyte count was reduced. Intensive phototherapy and antibiotics were started after ruling out other causes of hyperbilirubinemia. Blood group typing and advanced red cell serology workup were done. Antibody screening and identification was suggestive of the presence of anti-M antibody in both mother and baby. Intravenous immunoglobulin and red blood cell transfusions were given. Anti-M is capable of causing hemolytic disease of the fetus and newborn and prolonged anemia. Newborns with anemia should be evaluated for all the possible causes to establish a diagnosis.

Menstrual hygiene management and its determinants among adolescent girls in low-income urban areas of Delhi, India: a community-based study.

OBJECTIVES: Menstrual hygiene management (MHM) in developing countries is linked to human rights, social justice, and the education and empowerment of young girls. The objective of this study was to assess menstrual hygiene practices and their determinants among adolescent girls, including school dropouts, and the effects of pad distribution programs in urban resettlement areas of Delhi, India. METHODS: A cross-sectional study was conducted from March 2019 to February 2020 in urban resettlement colonies and 2 villages of Delhi among 1,130 adolescent girls aged 10 to 19 years, who were interviewed face to face. RESULTS: In total, 954 participants (84.4%) used only disposable sanitary pads, 150 (13.3%) used both sanitary pads and cloths, and 26 (2.3%) used only cloths (n=1,130). Most school-going girls utilized the scheme for pad distribution, but only two-thirds of the girls who were out of school utilized the scheme. In the adjusted analysis, girls with lower educational status, those who had dropped out of school, and those from the Muslim religious community were more likely to use cloths for MHM. CONCLUSION: More than 4 out of 5 adolescent girls in Delhi in low-income neighborhoods preferred sanitary pads for MHM. The government free pad scheme reached near-universal utilization among school-going girls (97%), but the subsidized pad scheme for girls who did not attend school was insufficiently utilized (75%).

Addressing stigma and discrimination in the Covid-19 pandemic: a public health ethics issue.

The Covid-19 pandemic continues to stalk the globe, ever since the first outbreak in December 2019. Variants of concern and fear of subsequent pandemic waves continue to challenge every nation. The virus has caught communities off-guard many times with grave consequences.

Hesitancy for Adult Vaccines Among Healthcare Providers and their Family Members in Delhi, India: A Cross-Sectional Study.

Objectives: Adult immunisation has recently emerged as an area of emphasis in research and policy. Increasing life expectancy, outbreaks like COVID-19, and the endemic nature of diseases like dengue, malaria have underscored its importance. Therefore, this study was carried out to assess hesitancy and the factors influencing the uptake of vaccines in adults. Methods: A descriptive cross-sectional study was conducted among the medical students and doctors affiliated to a medical college and tertiary care hospital in Delhi, India and their immediate family members in January 2021. Online data collection was done using the Google Form platforms. Data on awareness and perceptions regarding adult vaccination and immunisation status of participants was collected. The dataset was exported in the Microsoft Excel format and analysed with IBM SPSS Version 25 (Armonk, NY: IBM Corp). Results: A total of 461 adults responded to the survey. The most common reasons for vaccine hesitancy were fear of side effects (51.41%), lack of awareness of vaccines (49.46%), and the lack of national guidelines on adult vaccination (32.97%). Hesitancy for vaccines among those who were informed by healthcare workers of vaccine availability was highest for zoster vaccine (97.80%) and least for tetanus toxoid (57.62%). Significant hesitancy was also observed for pneumococcal, human papillomavirus, influenza and varicella vaccines. Conclusions: Reduced vaccine uptake due to vaccine hesitancy in adulthood is a major health concern. Framing national guidelines for adult vaccination in India and awareness generation to create a public demand for adult vaccination warrants prioritization.

Occupational Health Hazards of Rickshaw Pullers in Lower Middle Income Country, India.

Background: Rickshaw pullers work in unorganized sector. Ignorance, poverty, and strenuous physical exertion make them vulnerable to ill health and disease. Objectives: To assess the magnitude and pattern of morbidity, associated sociodemographic factors, and health-seeking behavior of the participants. Materials and Methods: A cross-sectional study was conducted on 305 participants. Predesigned, pretested questionnaire was used for data collection. Statistical Package for the Social Sciences (SPSS) 16 version was used for data analysis. Results: About 61% of the participants had morbidity in their lifetime and 49.5% fell sick in the last 15 days. Substance abuse in any form was reported by 73.1%. Grade-1 hypertension was reported in 28.2% and 7.5% was having grade-2 hypertension. Age, monthly income, substance abuse, and availing of health services were significantly associated with the development of health problems. Conclusion: Need to devise interventions that will focus on health awareness and early health-seeking behavior among the participants.

Molecular characterisation of Hepatitis E virus isolates from north India.

PURPOSE: Hepatitis E virus (HEV) is responsible for >50% of acute viral hepatitis (AVH) in developing countries. It has 4 major genotypes and various subtypes which vary in geographical distribution, clinical manifestations and epidemiological patterns. This study was conducted to characterise HEV isolates from north India to study the effect of host and viral factors on HEV infection. METHODS: Serum samples collected from 536 AVH patients admitted to Department of Medicine, King George's Medical University, Lucknow from July 2016 to June 2017 were screened for anti HEV IgM, anti HAV IgM, HBsAg and anti HCV antibodies using commercial ELISA kits. Samples either positive for anti HEV IgM antibodies (n â€‹= â€‹204) or negative for all 4 hepatotropic viruses (n â€‹= â€‹37) were enrolled and tested by real time PCR for HEV RNA. HEV RNA positive samples with high viral load were further subjected to nested PCR for amplification of capsid gene. Sequencing and phylogenetic analysis were performed. HEV strains isolated from this study were deposited to GenBank under accession numbers MG571274 to MG571283. RESULTS: Anti HEV IgM positivity was observed among 38% clinically suspected AVH cases. HEV RNA was detected in 31.8% seropositive HEV cases and additional 3 seronegative cases. Males outnumbered females and the most affected age group was of young adults. Maximum number of cases were seen during the months of June to September. Phylogenetic analysis showed that HEV strains in our study belonged to genotype 1a. Mortality in HEV infected pregnant females was 23.5% as compared to 2.4% in non-pregnant females. Adverse fetal outcome was recorded in 51% of HEV infected pregnancies. CONCLUSIONS: HEV genotype 1a is prevalent in our setting. HEV during pregnancy is associated with adverse maternal and fetal outcome.

Rehabilitation of the Shoulder Subluxation Based on Ultrasonographic Findings among Post Stroke Subjects: A Case Series.

BACKGROUND: Up to three-fourths of the poststroke subjects may experience shoulder subluxation as a challenging complication. The existing rehabilitation management is based on the clinical assessment. Ultrasonographic evaluation demonstrates findings, which cannot be discerned by the usual methods. OBJECTIVES: To determine the effect of rehabilitation protocol based on the sonographic findings of the subluxed shoulder on reduction of the subluxation and upper limb motor recovery. MATERIALS AND METHODS: Setting: Department of Occupational therapy of a Rehabilitation Institute. Study Design: A prospective case series. Subjects: 08 Poststroke hemiparetic patients with subluxed shoulder. Outcome measure: Ultrasongraphy of the bilateral shoulder joints, Fingerbreadth palpation method, Visual analog scale (VAS), Fugl-Meyer assessment of upper extremity (FMA-UE). Intervention: As per the findings of the sonography, management in the form of shoulder support, physical agent modalities, motor therapy, and precautions and positioning was provided to the subjects for the period of 3 months. RESULTS: Post intervention, the participants showed 1 to 6 mm of reduction of acromion-greater tuberosity distance in addition to the reduction of atrophy and soft tissue or joint effusion. Furthermore, the participants also exhibited FMA-UE change ranging from 5 to 21. CONCLUSION: The ultrasonographic evaluation explores objective measurement and involvement of specific soft tissues among poststroke subject with the shoulder subluxation. The management based on the sonographic findings is an objective and valid approach.

Perceptions of Frontline Workers, Female Health Workers, and School Teachers in Menstrual Hygiene Promotion among Adolescent Girls of Delhi, India: A Qualitative Study.

BACKGROUND: Government schemes for the promotion of Menstrual Hygiene Management (MHM) among adolescent girls in India are underpinned by crucial implementation efforts from the frontline health workers, community health workers, and school teachers. AIM: The aim of the study is to identify the perspectives on menstrual health and hygiene management with regard to government schemes for sanitary pad distribution to adolescent girls among the frontline workers and the government school teachers located in urban resettlement colonies in Delhi. METHODS: In-depth interviews were conducted with 30 accredited social health activisits, 30 Anganwadi Workers (AWW), and 30 auxiliary nurse midwives (ANMs) and five focus group discussions among 28 government school teachers from the middle, high, and secondary standard. RESULTS: Most participants recognized the phenomenon of menstruation-related problems in adolescent girls and were aware of some of the common sociocultural, religious, and hygiene-related menstrual restrictions prevalent in their communities. All the participants believed that the pad distribution scheme was highly beneficial. However, in spite of inclusion of menstrual health promotion in the school curriculum, teachers often lacked self-efficacy in discussing challenges and health concerns related to MHM with their students. CONCLUSIONS: Despite their potential as community resources for adolescent girls, FHWs, ANMs, and school teachers often fail to impart crucial menstrual hygiene information and skills-building needed toward achieving effective, safe, and optimal MHM.

Critical interpretative synthesis of herd immunity for COVID-19 pandemic.

INTRODUCTION: Countries globally are evaluating the concept of herd immunity and its critical role in the control of pandemic. The current paper attempts to conduct a critical interpretative synthesis (CIS) on the role of herd immunity in current COVID-19 pandemic. METHODS: CIS is tool for developing theoretical framework using interpretation drawn from relevant empirical and non-empirical sources. This review is done by formulating review question for literature search. Purposive sampling of literature was done followed by reciprocal translational analysis of extracted data. RESULTS: Herd immunity is indirect protection from a contagious infectious disease when a population is immune either through vaccination or natural immunity developed through previous infection. The reproduction number for COVID-19 in India was found to be 2.56 and herd immunity threshold as 61%. DISCUSSION: Exposing 71% young population in India to the SARS-CoV-2 infection can achieve herd immunity but with high morbidity as well as mortality. Vaccine are under process. Feco-oral transmission and reinfection of COVID 19 are major factors to develop or break the circle of herd immunity in community. "Immunity passport" can give false sense of security. Surveillance and seroprevalence studies assess immunity status, gradual exposure of infection to younger population and collaborative partnerships on organizations are few strategies to acquire herd immunity. CONCLUSION: Herd immunity is a measure for prevention and control of COVID-19 pandemic against the backdrop of mortality and morbidity. Vaccine can be boon but if herd immunity is to be acquired by natural infection then preparedness is necessary.

Development and Validation of a Menstruation-Related Activity Restriction Questionnaire among Adolescent Girls in Urban Resettlement Colonies of Delhi.

INTRODUCTION: Menstruation, a physiological phenomenon, till date is associated with myths, taboos, and malpractices. These interfere with the emotional, physical, and mental health of adolescent girls. This study attempts to draft a validated questionnaire to measure menstruation-related activity restriction. OBJECTIVE: The objective was to study activities restricted during menstruation among adolescent girls residing in urban resettlement colonies of Delhi and to develop and validate a questionnaire for menstruation-related activity restriction. MATERIALS AND METHODS: A community-based cross-sectional study was conducted among adolescent girls residing in urban resettlement colonies of Delhi during 2019. A multistage random sampling technique was used to select 1100 girls across four districts of Delhi. A 15-item questionnaire was developed by an expert committee and validated with principal component analysis (PCA). RESULTS: In total, 1100 adolescent girls were included in the study whose mean age was 15.8 (±2.1) years. School/college/work was missed due to menstruation in 60% of the adolescent girls, 66% were not comfortable during menstruation, and 92% were restricted from entering religious places. In exploratory factor analysis using PCA, 6 principal components were identified which had eigenvalues more than 1. CONCLUSION: Religious restrictions during menstruation (94%) were highly prevalent among adolescent girls, followed by restriction of routine activity (69%) and work/academically related activity (60%). Construct validity has identified a six-factor structure for the menstruation-related activity restriction questionnaire. This was identified as a valid and internally consistent tool to assess activities restricted during menstruation among Indian adolescent girls.

Practice Essentials of Imaging in Early Diagnosis of DDH.

INTRODUCTION: Developmental dysplasia of hip joint (DDH) is a dynamic progressive pathology which can tilt either way. The term strictly applies to primary dysplasia, where etiology is not clearly known. Secondary dysplasia can be due multiple causes, such as neuromuscular disorders, connective tissue disorders or skeletal syndromes. METHODS: The etiology being multifactorial, it needs a multidisciplinary team to address the issue at hand. The management starts antenatally with a detailed history of any risk factors and a dedicated ultrasound of the foetus, since forewarned is forearmed. At birth, a paediatrician having a keen sense of DDH will perform Barlow's or Ortolani's manoeuvre and can be the first one to sound the alarm in the event of positive findings. How and when a Radiologist needs to step in will depend on inter-departmental discussions between the paediatrician and the orthopedician. RESULTS: In the presence of positive clinical screening tests, and non-availability of ultrasound, a preliminary X ray pelvis AP view including both hip joints should be the requisitioned in a child of any age, particularly, if belonging to the high-risk group. If ultrasound is available, a screening exam till 6 months of age is recommended to rule out DDH. DISCUSSIONS: India is known for its vast numbers and little babies with occult diseases are the first to bear the brunt of conditions which have very few symptoms to start with. DDH is one such condition which most unfortunately expresses itself as a symptom only when it's too late, i.e., most often when the child begins to walk. Ultrasound is the modality of choice in neonates; however, since India is a country of modest means, in majority of the regions, radiographs still remain the first line of investigation.