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We obtain nontrivial solutions of some elliptic interface problems with nonhomogeneous jump conditions that arise in localized chemical reactions and nonlinear neutral inclusions. Our proofs in bounded domains use Morse theoretical arguments, in particular, critical group computations. An extension to the whole space is proved using concentration compactness arguments.

Objectives: Automated results for determining colistin susceptibility tests are unreliable, micro broth dilution requires expertise, and CBDE has limited dilutions. International Consensus Document of 2022 suggested that agar dilution was unacceptable due to varying results in the literature. Methods: The study was designed to evaluate the agar dilution method for colistin susceptibility in CRE isolates compared to CBDE. In the study, 108 carbapenem-resistant isolates were tested for Colistin susceptibility by Microbroth Dilution, agar dilution, and colistin broth disc elution. The comparisons were made using various statistical parameters. Results: The results of the agar dilution method revealed an essential agreement of 75 % and a categorical agreement of 92.5 %. The method showed a sensitivity of 75 % and a specificity of 97.7 %. The positive and negative predictive values were 88.2 % and 94.5 %, respectively. Youden's index was 0.727, indicating a moderate level of accuracy. Meanwhile, CBDE diagnostic accuracy tests were better, with Youden's index at 0.939. Conclusions: While CBDE demonstrated better accuracy parameters, it did not offer a broader MIC range. In contrast, agar dilution showed reasonable specificity and reliability for isolates with high MIC. Therefore, we propose using CBDE for screening and agar dilution as a supplementary test in the approach to colistin susceptibility.

The optimization of solar energy integration into the power grid relies heavily on accurate forecasting of solar irradiance. In this study, a new approach for short-term solar irradiance forecasting is introduced. This method combines Bayesian Optimized Attention-Dilated Long Short-Term Memory and Savitzky-Golay filtering. The methodology is implemented to analyze data obtained from a solar irradiance probe situated in Douala, Cameroon. Initially, the unprocessed data is augmented by integrating distinctive solar irradiation variables, and the Savitzky-Golay filter with Bayesian Optimization is used to enhance its quality. Subsequently, multiple deep learning models, including Long Short-Term Memory, Bidirectional Long Short-Term Memory, Artificial Neural Networks, Bidirectional Long Short-Term Memory with Additive Attention Mechanism, and Bidirectional Long Short-Term Memory with Additive Attention Mechanism and Dilated Convolutional layers, are trained and evaluated. Out of all the models considered, the proposed approach, which combines the attention mechanism and dilated convolutional layers, demonstrates exceptional performance with the best convergence and accuracy in forecasting. Bayesian Optimization is further utilized to fine-tune the polynomial and window size of the Savitzky-Golay filter and optimize the hyperparameters of the deep learning models. The results show a Symmetric Mean Absolute Percentage Error of 0.6564, a Normalized Root Mean Square Error of 0.2250, and a Root Mean Square Error of 22.9445, surpassing previous studies in the literature. Empirical findings highlight the effectiveness of the proposed methodology in enhancing the accuracy of short-term solar irradiance forecasting. This research contributes to the field by introducing novel data pre-processing techniques, a hybrid deep learning architecture, and the development of a benchmark dataset. These advancements benefit both researchers and solar plant managers, improving solar irradiance forecasting capabilities.

Problem considered: An emerging global threat, Candida auris infections have poor prognosis, high transmission rate, and potential for outbreaks. In India, prevalence of Candida auris invasive infection has been calculated to be 5.3 %. Strict surveillance and preventive measures must be implemented in intensive care units because of its propensity for rapid adaptation and potential for antifungal resistance. Methods: Outbreak investigational study was carried in paediatric and neonatal intensive care unit of a tertiary care hospital in eastern India. Clinical isolates from inpatients with candidemia were subjected to identification by microbiological tests. Deoxyribonucleic acid (DNA) sequencing done for molecular identification and determining clonal similarity of Candida auris isolates. Surveillance of intensive care units carried out to assess patient colonization, environmental contamination, and hand-carriage of yeast among healthcare workers following which strict infection control measures were implemented. Results: Blood isolates from four candidemia patients identified microbiologically as Candida auris. Environmental surfaces found contaminated with Candida auris by surveillance included Ultrasound guided (USG) Accu-probe and Blood-pressure (BP) cuff used for all patients admitted, molecular identification of which showed homology with patient isolates. However, patients and hospital environment no longer harboured Candida auris owing to stringent Infection Prevention and Control (IPC) measures taken. Conclusion: The article emphasises multidisciplinary approach towards investigation and containment of Candida auris outbreak and how prompt surveillance and simple preventive measures could eradicate Candida auris from patients and hospital setting.

Background Obstructive sleep apnea (OSA) is a common sleep disorder associated with cardiovascular risks. This study aimed to assess the prevalence of probable OSA and its relationship with cardiovascular risks and diseases focusing on age‐stratified young adults (20–40 years) and older (>40 years). Methods and Results The study used a cross‐sectional design, analyzing data from the National Health and Nutrition Examination Survey conducted between 2013 and 2018, comprising 9887 community‐dwelling adults aged ≥20 years. Probable OSA was determined on the basis of self‐report of OSA‐related symptoms (eg, snoring, gasping/breath cessation while sleeping). Cardiovascular risk factors, including hypertension, diabetes, hyperlipidemia, and metabolic syndrome, were evaluated according to established guidelines. Cardiovascular diseases (CVDs) included self‐reported heart conditions, including congestive heart failure, coronary heart disease, angina, heart attacks, and strokes. Individuals with probable OSA showed a significantly higher prevalence of health conditions, including hypertension (adjusted prevalence ratio [aPR], 1.19; P

Background The purpose of this study is to compare the prevalence of self‐reported cardiovascular conditions among individuals with moderate to severe traumatic brain injury (TBI) to a propensity‐matched control cohort. Methods and Results A cross‐sectional study described self‐reported cardiovascular conditions (hypertension, congestive heart failure [CHF], myocardial infarction [MI], and stroke) from participants who completed interviews between January 2015 and March 2020 in 2 harmonized large cohort studies, the TBI Model Systems and the National Health and Nutrition Examination Survey. Mixed‐effect logistic regression models were used to compare the prevalence of cardiovascular conditions after 1:1 propensity‐score matching based on age, sex, race, ethnicity, body mass index, education level, and smoking status. The final sample was 4690 matched pairs. Individuals with TBI were more likely to report hypertension (odds ratio [OR], 1.18 [95% CI, 1.08–1.28]) and stroke (OR, 1.70 [95% CI, 1.56–1.98]) but less likely to report CHF (OR, 0.81 [95% CI, 0.67–0.99]) or MI (OR, 0.66 [95% CI, 0.55–0.79]). There was no difference in rate of CHF or MI for those ≤50 years old; however, rates of CHF and MI were lower in the TBI group for individuals >50 years old. Over 65% of individuals who died before the first follow‐up interview at 1 year post‐TBI were >50 years old, and those >50 years old were more likely to die of heart disease than those ≤50 years old (17.6% versus 8.6%). Conclusions Individuals with moderate to severe TBI had an increased rate of self‐reported hypertension and stroke but lower rate of MI and CHF than uninjured adults, which may be due to survival bias.

Patients admitted to the hospital ward from the emergency department (ED) occasionally decompensate and require transfer to the intensive care unit (ICU). An emergency medicine (EM) curriculum focused on review of these ICU upgrade cases could improve resident knowledge related to patient acuity, critical illness, and appropriate disposition. Furthermore, initial identification of critical pathology in the ED and earlier admission to the ICU could reduce delays in care and improve patient outcomes. We performed a retrospective analysis to determine the effectiveness of a resident quality improvement curriculum evaluating cases where patients require transfer from the inpatient floor to the ICU within 12 hours of admission from the ED. We compared postgraduate year 2 (PGY-2) EM residents who participated in the ICU upgrades curriculum during their first year to PGY-2 EM residents who did not participate in the curriculum. Analysis of the 242 qualifying ICU upgrade cases from July 2019–October 2021 showed post-curriculum residents were responsible for an average of 1.0 upgrades per resident compared to an average of 1.54 upgrades per resident (P = 0.12) for pre-curriculum residents. Although there was no statistically significant difference in ICU upgrades between the groups, there was a trend toward decreased ICU upgrade cases for residents who participated in the curriculum. Common reasons for ICU upgrade included worsening respiratory distress requiring higher level of respiratory support, recurrent hypotension after initial intravenous fluid resuscitation requiring vasopressor support, and declining mental status. This retrospective study showed no significant difference in the number of ICU upgrades for residents who completed the ICU upgrades curriculum compared to residents who were not enrolled in the course. However, the study was likely underpowered to detect a significant difference in the groups, and there was a trend toward reduced ICU upgrades for residents who completed the curriculum. ICU upgrade cases were frequently associated with worsening respiratory status, hypotension, and mental status. These findings highlight the importance of reassessment of vital signs and mental status prior to determining disposition from the ED. Additional, larger studies are needed to better determine the curriculum’s impact on resident proficiency in recognizing critical illness and reducing ICU upgrades.

Post-Concussion Syndrome (PCS) refers to the persistence of physical, cognitive, and emotional symptoms following mild traumatic brain injury (mTBI)/concussion, occurring in roughly 15–30% of individuals. Hyperbaric oxygen therapy (HBOT) has been suggested as a potential treatment for PCS; however, the evidence to date is mixed due to inconsistencies in the treatment protocol and focus on veterans with combat-related injuries, which may not be generalizable to the general population. The goal of Hyperbaric Oxygen Therapy for Post-Concussion Syndrome (HOT-POCS) is to assess the efficacy and safety of HBOT for the treatment of PCS in the civilian population. This randomized, controlled pilot study will be using a standardized HBOT protocol (20 sessions of 100% O2 at 2.0 atm absolute [ATA]) compared with a true placebo gas system that mimics the oxygen composition at room air (20 sessions of 10.5% O2 and 89.5% nitrogen at 2.0 ATA) in a cohort of 100 adults with persistent post-concussive symptoms 3–12 months following injury. Change in symptoms on the Rivermead Post-concussion Questionnaire (RPQ) will be the primary outcome of interest. Secondary outcomes include the rate of adverse events, change in the quality of life, and change in cognitive function. Exploratory outcome measures will include changes in physical function and changes in cerebral brain perfusion and oxygen metabolism on MRI brain imaging. Overall, the HOT-POCS study will compare the efficacy of a standardized HBOT treatment protocol against a true placebo gas for the treatment of PCS within 12 months after injury.

The aim of this systematic review and meta-analysis was to summarize and compare the available evidence on the level of vitamin D and antioxidant trace elements between the keratoconus (KC) patients and healthy controls. Seven case–control studies with 830 subjects were found eligible with a systematic search using PubMed, SCOPUS, Web of Science, and EMBASE till November 21, 2021. Data were synthesized with a DerSimonian and Laird random-effects method of meta-analysis. The mean serum vitamin D level was significantly lower in the patients with KC [standardized mean difference (SMD): −0.71; P < 0.001] as compared with the control group. The mean serum vitamin D level decreased more in the progressive patients (SMD: −0.80; P = 0.016) than in the stable patients (SMD: −0.66; P < 0.001) when compared with the control group. The mean serum zinc level was found significantly lower in the patients with KC compared with the control group (SMD: −1.98; P = 0.005). Pooled analysis based on the two studies showed significantly lower mean selenium levels in the KC patients (SMD: −0.34; P = 0.003). Regular evaluation of serum vitamin D, zinc, and selenium levels among the patients with KC at disease onset and future follow-ups could be promising in predicting the progressive disease and disease severity.

Abstract Background: Peri-diagnostic vaccination contemporaneous with SARS-CoV-2 infection might boost antiviral immunity and improve patient outcomes. We investigated, among previously unvaccinated patients, whether vaccination (with the Pfizer, Moderna, or J&J vaccines) during the week before or after a positive COVID-19 test was associated with altered 30-day patient outcomes. Methods: Using a deidentified longitudinal EHR repository, we selected all previously unvaccinated adults who initially tested positive for SARS-CoV-2 between December 11, 2020 (the date of vaccine emergency use approval) and December 19, 2021. We assessed whether vaccination between days –7 and +7 of a positive test affected outcomes. The primary measure was progression to a more severe disease outcome within 30 days of diagnosis using the following hierarchy: hospitalization, intensive care, or death. Results: Among 60,031 hospitalized patients, 543 (0.91%) were initially vaccinated at the time of diagnosis and 59,488 (99.09%) remained unvaccinated during the period of interest. Among 316,337 nonhospitalized patients, 2,844 (0.90%) were initially vaccinated and 313,493 (99.1%) remained unvaccinated. In both analyses, individuals receiving vaccines were older, more often located in the northeast, more commonly insured by Medicare, and more burdened by comorbidities. Among previously unvaccinated patients, there was no association between receiving an initial vaccine dose between days −7 and +7 of diagnosis and progression to more severe disease within 30 days compared to patients who did not receive vaccines. Conclusions: Immunization during acute SARS-CoV-2 infection does not appear associated with clinical progression during the acute infectious period.

Despite not being uniform, urban economic growth usually shows some inconsistency. Urban sustainable development may be harmed if the financial instability goes above a particular threshold. This article examines the current status of India's macro-economic real-time management of early warning alert systems and information warehouse-related innovations. In order to deal with the significant loss caused by the increased variation of an urban economy, it analyzes and explicates the position of Internet of Things (IoT) technology in the macro-economic alert system. This reviews the development path of financial monitoring and early alerting system whichsorts out and compares numerous popular economic monitoring techniques.Depending on IoT technology, the urban economic reports surveillance & advance warning system has conducted research on information transfer, tracking, forecasts, analysis, and presentation. After simulating the system, the proposed research's findings indicate that the overall accuracy of the model's macroeconomic fluctuation forecast approaches 80%, which may be used in real life.

Abstract There is emerging evidence demonstrating an association between maternal polycystic ovary syndrome (PCOS) and autism spectrum disorder (ASD) in children, however, the cumulative effect of maternal PCOS on the development of ASD or other neuropsychiatry disorders (NPD) in children and separately for males and females has not been examined. We sought to systematically evaluate the influence of maternal PCOS on a wide range of NPD including ASD, attention deficit hyperactivity disorder (ADHD), chronic tic disorder (CDT), other behavior disorders, anxiety, depression, bipolar disorder, schizophrenia in children as well as in women of reproductive age only. We queried electronic databases including PubMed, EMBASE, and Google Scholar, until March 2021. We used DerSimonian and Laird (D-L) random effects method to compute pooled effect size in terms of odds ratio (OR). Nineteen studies (1667851 mothers, 2260622 children) were included in this study. Mothers with PCOS had an increased odds of children diagnosed with ASD (OR = 1.40, p

Abstract Several comorbidities have been shown to be associated with coronavirus disease 2019 (COVID-19) related severity and mortality. However, considerable variation in the prevalence estimates of comorbidities and their effects on COVID-19 morbidity and mortality have been observed in prior studies. This systematic review and meta-analysis aimed to determine geographical, age, and gender related differences in the prevalence of comorbidities and associated severity and mortality rates among COVID-19 patients. We conducted a search using PubMed, Scopus, and EMBASE to include all COVID-19 studies published between January 1st, 2020 to July 24th, 2020 reporting comorbidities with severity or mortality. We included studies reporting the confirmed diagnosis of COVID-19 on human patients that also provided information on comorbidities or disease outcomes. We used DerSimonian and Laird random effects method for calculating estimates. Of 120 studies with 125,446 patients, the most prevalent comorbidity was hypertension (32%), obesity (25%), diabetes (18%), and cardiovascular disease (16%) while chronic kidney or other renal diseases (51%, 44%), cerebrovascular accident (43%, 44%), and cardiovascular disease (44%, 40%) patients had more COVID-19 severity and mortality respectively. Considerable variation in the prevalence of comorbidities and associated disease severity and mortality in different geographic regions was observed. The highest mortality was observed in studies with Latin American and European patients with any medical condition, mostly older adults (≥ 65 years), and predominantly male patients. Although the US studies observed the highest prevalence of comorbidities in COVID-19 patients, the severity of COVID-19 among each comorbid condition was highest in Asian studies whereas the mortality was highest in the European and Latin American countries. Risk stratification and effective control strategies for the COVID-19 should be done according to comorbidities, age, and gender differences specific to geographical location.

Abstract Background Coronavirus disease (COVID-19) has been associated with adverse pregnancy outcomes. Due to the lack of effective treatments for COVID-19, it becomes imperative to assess the geographical differences and trends in the current clinical care and outcomes of COVID-19 in pregnant women. Methods A PubMed search was performed to screen articles reporting therapeutics and outcomes of confirmed COVID-19 in pregnant women prior to August 27, 2020. We performed searches, quality assessments of eligible studies, extracted and reported data according to PRISMA guidelines. Meta-analyses and cumulative meta-analyses of proportions were performed for estimating each outcome and their pattern over time respectively. Results One thousand two hundred thirty nine pregnant women with COVID-19 from 66 studies were analyzed. In case series analysis reflecting average-risk patients, the proportion of oxygen support, antibiotics, antivirals, and plasma therapy administration except for hydroxychloroquine was substantially higher in Asian studies (55, 78, 80, 6, and 0%) compared to the US (7, 1, 12, 0, and 7%) or European (33, 12, 14, 1, and 26%) studies, respectively. The highest preterm birth and the average length of hospital stay (35%, 11.9 days) were estimated in Asian studies compared to the US studies (13%, 9.4 days) and European studies (29%, 7.3 days), respectively. Even in case reports reflecting severe cases, the use of antivirals and antibiotics was higher in Asian studies compared to the US, Latin American, and European studies. A significant decline in the use of most therapeutics along with adverse outcomes of COVID-19 in pregnant women was observed. Conclusions Geographical differences in therapeutic practice of COVID-19 were observed with differential rates of maternal and clinical outcomes. Minimizing the use of some therapeutics particularly antibiotics, antivirals, oxygen therapy, immunosuppressants, and hydroxychloroquine by risk stratification and careful consideration may further improve maternal and clinical outcomes.

Day traders in the financial markets are under constant pressure to make rapid decisions and limit capital losses in response to fluctuating market prices. As such, their emotional state can greatly influence their decision-making, leading to suboptimal outcomes in volatile market conditions. Despite the use of risk control measures such as stop loss and limit orders, it is unclear if these strategies have a substantial impact on the emotional state of traders. In this paper, we aim to determine if the use of limit orders and stop loss has a significant impact on the emotional state of traders compared to when these risk control measures are not applied. The paper provides a technical framework for valence-arousal classification in financial trading using EEG data and deep learning algorithms. We conducted two experiments: the first experiment employed predetermined stop loss and limit orders to lock in profit and risk objectives, while the second experiment did not employ limit orders or stop losses. We also proposed a novel hybrid neural architecture that integrates a Conditional Random Field with a CNN-BiLSTM model and employs Bayesian Optimization to systematically determine the optimal hyperparameters. The best model in the framework obtained classification accuracies of 85.65% and 85.05% in the two experiments, outperforming previous studies. Results indicate that the emotions associated with Low Valence and High Arousal, such as fear and worry, were more prevalent in the second experiment. The emotions associated with High Valence and High Arousal, such as hope, were more prevalent in the first experiment employing limit orders and stop loss. In contrast, High Valence and Low Arousal (calmness) emotions were most prominent in the control group which did not engage in trading activities. Our results demonstrate the efficacy of our proposed framework for emotion classification in financial trading and aid in the risk-related decision-making abilities of day traders. Further, we present the limitations of the current work and directions for future research.

Aim: Present systematic review and meta-analysis examined the burden of psychological reactions predominantly anxiety, depression, stress, and insomnia during the novel COVID-19 pandemic phase among the frontline healthcare, nonfrontline healthcare, and general population. Material and Methods: PubMed, EMBASE, and SCOPUS were searched for studies between January 1, 2020, and May 25, 2020. Brief protocol of the systematic review was registered with the PROSPERO database, (CRD42020186229). Any study that reported the burden of at least one of psychological reactions including anxiety or depression or stress or insomnia was eligible. Heterogeneity was assessed using I2 statistic and results were synthesized using random-effect meta-analysis. Results: Out of 49 eligible studies, 41 databases from 37 studies reported anxiety, 39 databases (35 studies) reported depression, 20 studies reported stress and 12 databases from 11 studies reported insomnia. The overall prevalence for anxiety, depression, stress, and insomnia was 26.3%, 25.9%, 26.2%, and 31.3%, respectively. Prevalence of anxiety, depression, stress, and insomnia were found highest among the frontline healthcare as compared to general healthcare workers and the general population. Conclusion: Anxiety, depression, stress, and insomnia were more prevalent among frontline health-care workers compared to general. Such increased prevalence is prompting toward the global mental health emergency. Therefore, a call of urgent attention and pan-region effective mental-health intervention are required to mitigate these psychological reactions.

Objective: To investigate the psycho-social factors associated with COVID-19 and the nationwide lockdown in India. Study design: An online survey was conducted from April 11 through April 16, 2020 in 28 states and 8 union territories (UT) of India. The potential participants were recruited using snowball sampling procedure. Methods: A cross-sectional online survey was conducted among the people of all states in India. A spatial analysis was performed and Moran's I statistic was applied to investigate the overall clustering of locations. Fisher's exact test was used to investigate associations. GeoDa and R console were used to analyze the data. A total of 1316 responses were received. Results: Those worried for their family's health were likely to follow the lockdown measures(p

Abstract Background Inflammation has been implicated in the initiation and perpetuation of non‐valvular atrial fibrillation (AF). However, there is a lack of similar data on AF in rheumatic heart disease (RHD). The objective of this study was to analyze the association of inflammation as measured by serum inflammatory biomarkers with AF in rheumatic mitral stenosis (Rh‐MS). Methods A comparative cross‐sectional analytical study was conducted on 181 Rh‐MS patients in normal sinus rhythm (NSR; n = 69), subclinical transient AF (SCAF; detected by 24‐hours Holter monitoring; n = 30) and chronic AF (n = 82). Serum hs‐CRP, IL‐6, and sCD‐40L were assessed using ELISA immunoassay and compared in all groups of Rh‐MS with or without AF. Results We found significantly higher serum hs‐CRP and sCD‐40L levels in the overall AF (Chronic AF + SCAF) group (hs‐CRP: 4.5 ± 3.4 vs 2.3 ± 2.9 mg/L, P

Background: Atypical antipsychotics, widely used in many psychiatric diseases, are known to cause metabolic syndrome (MetS). But, there is sparse of prospective study to see the effect of atypical antipsychotics causing MetS in drug naïve or drug free patients among the Indian population. This study aimed to determine the incidence of MetS and change in individual risk factor for MetS in schizophrenia and mood disorder patients after three months of receiving atypical antipsychotics. Method: Sixty patients of schizophrenia (n=40) and mood disorders (n=20) were screened at the baseline and all of them were prospectively followed up for the occurrence of MetS after three months. Results: By applying the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP/ATP III) modified criteria for Asian, the incidence of MetS was found to be 11.66%. When analysing the individual risk factor for MetS, the mean value from baseline to follow-up was weight (in kg) 58.55±10.03 to 59.80±10.24 (p

Summary: Background: Given the projected trends in population ageing and population growth, the number of people with dementia is expected to increase. In addition, strong evidence has emerged supporting the importance of potentially modifiable risk factors for dementia. Characterising the distribution and magnitude of anticipated growth is crucial for public health planning and resource prioritisation. This study aimed to improve on previous forecasts of dementia prevalence by producing country-level estimates and incorporating information on selected risk factors. Methods: We forecasted the prevalence of dementia attributable to the three dementia risk factors included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 (high body-mass index, high fasting plasma glucose, and smoking) from 2019 to 2050, using relative risks and forecasted risk factor prevalence to predict GBD risk-attributable prevalence in 2050 globally and by world region and country. Using linear regression models with education included as an additional predictor, we then forecasted the prevalence of dementia not attributable to GBD risks. To assess the relative contribution of future trends in GBD risk factors, education, population growth, and population ageing, we did a decomposition analysis. Findings: We estimated that the number of people with dementia would increase from 57·4 (95% uncertainty interval 50·4–65·1) million cases globally in 2019 to 152·8 (130·8–175·9) million cases in 2050. Despite large increases in the projected number of people living with dementia, age-standardised both-sex prevalence remained stable between 2019 and 2050 (global percentage change of 0·1% [–7·5 to 10·8]). We estimated that there were more women with dementia than men with dementia globally in 2019 (female-to-male ratio of 1·69 [1·64–1·73]), and we expect this pattern to continue to 2050 (female-to-male ratio of 1·67 [1·52–1·85]). There was geographical heterogeneity in the projected increases across countries and regions, with the smallest percentage changes in the number of projected dementia cases in high-income Asia Pacific (53% [41–67]) and western Europe (74% [58–90]), and the largest in north Africa and the Middle East (367% [329–403]) and eastern sub-Saharan Africa (357% [323–395]). Projected increases in cases could largely be attributed to population growth and population ageing, although their relative importance varied by world region, with population growth contributing most to the increases in sub-Saharan Africa and population ageing contributing most to the increases in east Asia. Interpretation: Growth in the number of individuals living with dementia underscores the need for public health planning efforts and policy to address the needs of this group. Country-level estimates can be used to inform national planning efforts and decisions. Multifaceted approaches, including scaling up interventions to address modifiable risk factors and investing in research on biological mechanisms, will be key in addressing the expected increases in the number of individuals affected by dementia. Funding: Bill & Melinda Gates Foundation and Gates Ventures.

Introduction: Donated blood is very crucial and life-saving for those who require large volumes of blood in any medical emergency. Many blood donation camps are routinely organized to fill this void of demand and supply. In a university campus associated with a hospital, it is important that student volunteers should contribute towards the increase in demand for blood during times of crisis. This makes it imperative to understand their perception of this noble cause. Methods: A descriptive cross-sectional study was conducted among 354 volunteers of a university campus using convenience sampling. The primary outcome was to assess the factors that influence voluntary blood donation among the volunteers. The adjusted association was performed using logistic regression. R Console was used for statistical analysis. Odds ratios and p-value < 0.05 with 95% confidence intervals were calculated to determine the level of significance. Results: A total of 354 responses were received and analysed. Among these, 38.98%, (n=138) participants had donated blood at least once. Factors that were significantly associated with blood donation were gender, being a member of an NGO, frequency of volunteering activities, fear of needles, and belief that they would acquire the disease during blood donation. Conclusion: The majority of the participants had good knowledge of blood donation, but their attitude and practice did not fall along the same lines. The study also highlighted that attitude towards donating blood is high among the participants who are associated with the NGOs or participate in voluntary activities. Voluntary work induces a ‘sense of giving something to the society which appears to be facilitating factor and an effective measure to encourage blood donation among youth.

Background: Despite several programs and policies to turn down the burden of malnutrition in the country, the rank of India in the Global Hunger Index (GHI) is 102 among 117 countries, which indicates a serious hunger situation. It is essential to design more specific interventions by focusing on the key determinants that may directly or indirectly influence malnutrition in India.Methods: Utilizing data from the National Family and Health Survey-4 (NFHS) (2015-16), we developed a structural equation model to find the direct, indirect, and total effect of various determinants on stunting, wasting, and underweight. We used spatial analysis to identify local occurrences of factors that are critical in controlling malnutrition. A p-value of 0.05 was considered to be significant throughout the study. Analysis was performed using STATA (version 15.1MP) and GeoDa software (version 1.14).Results: A final sample of 90, 842 children of 0–24 months of age was selected for the analysis. The CFI and TLI values of 0.98 and 0.93, respectively, are indicative of a good fit model. Moran's I value of global spatial autocorrelation for the widespread presence of diarrhea, poor drinking water source, exclusive breastfeeding, low birth weight, no prenatal visits, poor toilet facility was observed to be 0.446, 0.638, 0.345, 0.439, 0.620, and 0.727, respectively.Conclusion: A robust direct relation was observed for diarrhea, exclusive breastfeeding, and children born with stunting, underweight, and wasting. The variables associated indirectly with the outcome variables were the education of the mother, residence, and desired pregnancy. The identification of hotspots through spatial analysis would help revive control strategies in the affected area according to geographical needs. It is extensively addressed that interventions related to health and nutrition during the first 1, 000 days of life is crucial to seize the upshoot of growth floundering among children.

Background: Hands are the most common vehicle for the transmission of pathogens within the healthcare environment. Hand hygiene is the leading measure for reducing healthcare-associated infections (HCAIs) and preventing the spread of antimicrobial resistance. Objective: An interventional study was carried out to evaluate the knowledge, attitude and practices of hand hygiene among third semester medical students. Materials and methods: A total of 152 medical students were evaluated using a pretest self-structured questionnaire to assess the knowledge, attitude and practices regarding hand hygiene. The students were trained by faculty of microbiology vigorously with the help of a lecture and demonstration on hand hygiene followed by hands-on training. The same group of students were then distributed the post-training questionnaire. The pre-training and post training data was analyzed and compared. Result: There was a significant improvement in knowledge, attitude and practice towards hand hygiene among students after intervention, as seen on comparison of results of post-test questionnaire from its pre-test counter-part because the doubts in the mind of the students got cleared in the education sessions. Conclusion: Targeting medical students and teaching them the good standard practices was fruitful as they were young, easy to mold and enthusiastic and above all they are the future doctors. Such educational intervention regarding hand hygiene will be carried out for each batch of medical students in future. Keywords: Hand hygiene, Medical students, Targeted educational intervention

Background: Population aging is inevitable. Old age is marked with health problems because of aging process, long-term chronic illnesses, also associated with social and mental problems. Objectives: To determine the pattern of physical morbidities in geriatric population and to study the utilization of health services among them. Methods: A cross-sectional study was undertaken from April to September 2017, among 270 consenting elderly people, residing in urban slums under field practice area of a medical college, using a structured interview schedule. Results: Among the 270 elderly, 36.30% were males, 80% belonged to nuclear families. A total of 262 reported of some morbidity, 61.85% had hypertension, 45.19% had diabetes, 37.78% had acid peptic disease, and 51.08% reported to have 1--3 morbidities. Majority (41.85%) of them had visited a physician on an average of 4--6 times in the preceding year. A total of 84.81% went to the urban health center, whereas 24.81% to a government hospital for treatment. Reasons cited for preference of health facility were “free consultation” and “nearby location” (85.19%). A total of 90.74% received allopathic medicines. Conclusion: Prevalence of morbidity was found to be high, which can be attributed to their compromised living conditions. Health-seeking behavior was found to be good.

Background: Legionnaires' disease (LD) is a potentially fatal pneumonia predominantly caused by infection due to Legionella pneumophila although more than 50 other Legionella species are described. Water systems contaminated with Legionella spp. are the implicated sources of Legionnaires' disease. In this study, we aimed to assess Legionella contamination in the water sources of a tertiary care hospital and to determine the virulence properties and molecular characteristics of L. pneumophila environmental isolates.Methods: During May 2015 through August 2018, a total of 201 hospital water samples were tested for L. pneumophila by standardized culture procedures; environmental isolates were examined for the presence of two virulence genes: Legionella vir homolog (lvh) and repeats in structural toxin (rtxA) by PCR. The genotyping of isolates was performed by sequence-based typing (SBT) according to the protocol of the European Study Group for Legionella Infections (ESGLI).Results:L. pneumophila was isolated from 38/201 (18.9%) water samples; among the 46 isolates, the lvh locus was present in 45 (97.8%), the rtxA locus was found in 45 (97.8%), and both loci were found in 44 (95.7%) isolates. A total of 23 sequence types (STs) were identified among the 44 isolates (index of discrimination [IOD] of 0.929), and 11/23 (47.8%) STs were new to the ESGLI database.Conclusions: The study results showed genetic diversity in L. pneumophila isolates from the hospital environment along with a high percentage of pathogenicity loci. Besides, certain STs may have an increased ability to cause legionellosis, thus requires specific infection control and prevention strategies whenever identified.

Introduction and aim. Patients with acute on chronic liver failure (ACLF) have abnormal conventional coagulation tests- platelet count and international normalized ratio (INR). Thromboelastography (TEG) is a rapid, point-of-care assay, more comprehensive than platelet count and INR as it assesses for platelet adequacy(number and function), coagulation factors and clot retraction. The aim of the study was to evaluate the TEG parameters in patients with ACLF, chronic liver disease having acute decompensation (AD) and healthy subjects (HC).Material and methods. TEG parameters were assessed in patients with ACLF and AD within 24 h of admission. Consecutive patients were included in the study over 12 months. Healthy subjects were recruited as controls.Results. 179 patients were included- 68 ACLF, 53 AD and 58 HC. The mean values of INR in ACLF, AD and HC groups were 2.9 ± 1.4, 1.6 ± 0.4 and 1.1 ± 0.2; P < 0.001. Among TEG parameters - maximum amplitude (MA) was low in ACLF and AD patients as compared with HC (53.8 ± 15, 58.3 ± 13.9 mm and 67.2 ± 12.1 mm, respectively; P < 0.001). Lysis at 30 min (LY30) was high in ACLF patients, as compared to AD and HC (8.6 ± 14.1%, 5.0 ± 9.5% and 4.9 ± 9.8%, respectively; P = 0.060). There were no differences in r time, k time, and alpha angle between groups; normal in >90% patients. There was no difference in TEG parameters between different ACLF grades, whereas CCTs were more deranged with increasing grades of ACLF.Conclusion. Despite abnormal conventional coagulation tests, TEG parameters in ACLF patients are essentially normal, except reduced maximum amplitude. Future studies are needed to explore the utility of TEG in clinical management of ACLF patients.

BACKGROUND: No data is available evaluating the difference in serum versus plasma sample assay of commonly tested parameters in the emergency department, where the sample processing time can be significantly reduced if plasma is used for analysis instead of conventionally used serum. Hence, this study aimed to evaluate the differences in serum versus plasma sample estimation of commonly evaluated biochemical parameters using dry chemistry technology. MATERIALS AND METHODS: Paired blood samples were collected from a single venipuncture of 405 patients admitted to the emergency department. Dry chemistry autoanalyzer (Vitros-350, Ortho Clinical Diagnostics) was used to process all the samples. RESULTS: Data from 401 patients were analyzed. Percentage differences between serum versus plasma samples for all analytes ranged from 0.0% to 57.44% and were

Abstract Background Neoadjuvant chemotherapy (NACT), a standard of care for locally advanced breast cancer patients, is widely used for early breast cancer patients also. The varying role of regimens used as NACT needs to be investigated. Despite availability of some randomized controlled trials (RCTs), it is unclear which treatment regimen suits best. Further, there is no study comparing all the three regimens. Accordingly, present study will compare the efficacy of anthracyclines, taxanes, and targeted therapy administered in neoadjuvant setting on the basis of oncological outcomes and functional outcomes. Method/design Online databases PubMed and Cochrane Register of Controlled Trials will be searched to acquire eligible studies. Further, content of relevant journals, references of relevant articles, and proceedings of major related conference will also be searched. The RCTs comparing any of abovementioned regimen as NACT on breast cancer patients will be eligible. Two reviewers independently and in duplicate will screen the records on the basis of title and abstract and complete full-text review to determine eligibility. Similarly, data extraction and risk of bias assessment will be done by two independent reviewers. The pair-wise meta-analysis as well as network meta-analysis will be conducted to assess the relative efficacy of anthracyclines, taxanes, and targeted therapy regimens. Discussion The present systematic review will improve the understanding of the relative efficacies of the three treatment regimens and possibly guide the clinical practices by providing the current best evidence on the efficacy of various regimens of NACT in the management of breast cancer patients. Systematic review registration PROSPERO (CRD42016027236).

Introduction and aim. Multiple prognostic scores are available for acute liver failure (ALF). Our objective was to compare the dynamicity of model for end stage liver disease (MELD), MELD-sodium, acute liver failure early dynamic model (ALFED), chronic liver failure (CLIF)-consortium ACLF score and King’s College Hospital Criteria (KCH) for predicting outcome in ALF.Materials and methods. All consecutive patients with ALF at a tertiary care centre in India were included. MELD, MELD-Na, ALFED, CLIF-C ACLF scores and KCH criteria were calculated at admission and day 3 of admission. Area under receiver operator characteristic curves (AUROC) were compared with DeLong method. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) and diagnostic accuracy (DA) were reported.Results. Of the 115 patients included in the study, 73 (63.5%) died. The discrimination of mortality with baseline values of prognostic scores (MELD, MELD-Na, ALFED, CLIF-C ACLF and KCH) was modest (AUROC: 0.65-0.77). The AUROC increased on day 3 for all scores, except KCH criteria. On day 3 of admission, ALFED score had the highest AUROC 0.95, followed by CLIF-C ACLF 0.88, MELD 0.81, MELD-Na 0.77 and KCH 0.52. The AUROC for ALFED was significantly higher than MELD, MELD-Na and KCH (P < 0.001 for all) and CLIF-C ACLF (P = 0.05). ALFED score > 4 on day 3 had the best sensitivity (87.1%), specificity (89.5%), PPV (93.8%), NPV (79.1%), LR positive (8.3) and DA (87.9%) for predicting mortality.Conclusions. Dynamic assessment of prognostic scores better predicts outcome. ALFED model performs better than MELD, MELD, MELD-Na, CLIF-C ACLF scores and KCH criteria for predicting outcome in viral hepatitis-related ALF.

Fusarium species are among the most commonly isolated causes of fungal keratitis. Most species of the genus Fusarium belong to Fusarium solani species complex (FSSC). Fusarium lichenicola, a member of the FSSC complex, is a well-established plant and human pathogen. However, reports of fungal keratitis due to Fusarium lichenicola have not been frequently reported. To the best of our knowledge, only twelve cases of Fusarium lichenicola keratitis have been reported in the past fifty years. Clinical cases of Fusarium lichenicola may have most likely been misidentified because of the lack of clinical and microbiological suspicion, as well as inadequate diagnostic facilities in many tropical countries where the burden of the disease may be the highest. We report a case of fungal keratitis caused by Fusarium lichenicola and present a global review of the literature of all cases of fungal keratitis caused by this potentially blinding fungus.

Background: Gallbladder carcinoma (GBC) exhibits poor prognosis due to its detection at an advanced stage. Upregulation of lysosomal cysteine proteases cathepsin L (CTSL) and cathepsin B (CTSB) has been implicated in several tumorigenic processes. However, no such information in GBC was available. Therefore, the present study was planned to investigate the expression and clinical significance of these cathepsins in GBC.Methods: Activities of CTSL and CTSB were assayed in the gallbladder (GB) tissues obtained from GBC patients (n = 43) and control subjects (n = 69). Protein and mRNA levels were quantified using immunohistochemistry and real-time PCR (qPCR), respectively. Finally, serum levels of CTSL and CTSB were estimated by ELISA. Receiver operating characteristic (ROC) curve analysis was used for the assessment of sensitivity, specificity, and diagnostic accuracy of these cysteine cathepsins in GBC. The association of combined CTSL and CTSB activity with overall survival was assessed using Kaplan Meier survival analysis.Results: The expression and activity of both CTSL and CTSB were significantly increased (p < 0.050) in tumors of GBC patients as compared to controls. Enzymatic activity of CTSL+B and CTSB exhibited a strong positive association with tumor stage and lymph node involvement in GBC (p < 0.050). Interestingly, the elevated activity of combined CTSL+B was also associated with increased mortality in these patients. Furthermore, significantly enhanced levels of serum CTSL and CTSB were also observed in GBC (p < 0.050) as compared to controls. ROC analysis revealed high diagnostic significance of serum CTSB and CTSL for distinguishing GBC patients from controls with an area under the curve (AUC) of 82 and 77%, respectively.Conclusion: This study, for the first time, demonstrates the clinical significance of CTSL and CTSB overexpression in GBC. Our findings may help improve the clinical management of this carcinoma.

Introduction: In Rheumatoid Arthritis (RA), extra-articular disease is single most important cause of morbidity and mortality. Although DAS-28 score is used for disease assessment in RA, extra-articular manifestations are not included in the same. Therefore an initial attempt was done for development of a composite Disease Assessment Score for Extra-Articular Manifestations (DAS-EAM) based on rheumatologists consensus. Aim: The study was an initial attempt to make a composite disease assessment score for EAMs in RA. Materials and Methods: A hospital based cross-sectional study done on 226 RA patients with various clinical parameters with waiting scores were included to develop the DAS-EAM score. This was compared with DAS-28 and Physician’s Global Assessment score and other demographic parameters and serology {RF, Anti-Cyclic Citrullinated Peptide (Anti-CCP)}. A Pearson’s correlation coefficient and Kappa agreement were calculated to find out the correlation as well as agreement between DAS-EAM score, Physician’s Global Assessment score and DAS-28 scores. Results: Patient’s age was significantly different among the DAS-EAM score (p=0.001). Other parameters such as gender, duration of disease and serology were not significantly associated with DAS-EAM score. There was no agreement between DAS-28 and DAS EAM score. Conclusion: Despite the major limitations such as single centered cross-sectional study design with small sample size, this is an initial attempt for development of a composite tool for extra-articular disease in RA.

Introduction: Evaluation of febrile infants and children without focus possess a great clinical concern. Although several biochemical indices indicate diagnosis towards bacterial agents, combining low cost and easily performed haematological parameters could reasonably predict the presence of Bacterial Infection (BI). Aim: To assess the value of C-reactive Protein (CRP) alone and in conjunction with total White Blood Cell (WBC) count and Absolute Neutrophil Count (ANC) in predicting bacterial infection in febrile children. Materials and Methods: A prospective study was conducted in the Department of Paediatrics of a tertiary care hospital among children aged 1 month to 14 years admitted with fever for >24 hours. Data were collected from 97 consecutive children in whom CRP and total blood count was advised at admission. These data were analysed to predict the presence of BI by investigating the diagnostic performance of CRP, WBC and ANC using standard statistical software Stata version 13.1. Results: BI was diagnosed in 41 children. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Diagnostic Accuracy (DA) of CRP for BI among the febrile infants were 83%, 75.0%, 71%, 86% and 78% respectively. The sensitivity and specificity were 61% and 98% when all the three parameters CRP, WBC and ANC were positive and were 95% and 45% when any of these parameters was positive. Conclusion: A definitive cut-off value of 1.2 mg/L for CRP is a reasonably good predictor of BI among febrile children. However, addition of other laboratory parameters (total leukocyte count and ANC may enhance clinician’s ability to discriminate bacterial from non BIs.

Introduction: Enterococci are recognized as opportunistic pathogens, as well as commensals in both humans and animals. They are an important cause of nosocomial infections, difficult to treat, as the organism have intrinsic and acquired resistance to many antibiotics. Aim: To isolate and identify clinically relevant Enterococcus up to species level from all the clinical samples processed in the microbiology laboratory and also to study their resistance pattern. Materials and Methods: A prospective study was carried out for a period of one year from May 2014 to April 2015 at the Department of Microbiology, Subharti Medical College, Meerut, Uttar Pradesh, India. A total of 200 isolates of Enterococcus species from 15342 clinical samples obtained from IPD/OPD patients irrespective of age, having suspicion of bacterial infection were processed in the microbiology laboratory. Identification was done with standard biochemical methods. Antibiotic susceptibility testing was done on Muller Hilton agar plate by Kirby Bauer disc diffusion method. High-Level Gentamycin Resistance (HLGR) and High-Level Streptomycin Resistance (HLSR) were further confirmed by Agar dilution method and Broth microdilution method. Vancomycin and linezolid resistance was further confirmed by Agar dilution method and MIC was calculated by using VITEK 2, Biomerieux. All methodology was followed as per Clinical and Laboratory Standards Institute (CLSI) M100-S 24, 2014 guidelines. Results: E. faecalis (n=169, 84.5%) was the predominant species isolated, followed by E. faecium (n=27, 13.5%) and E. casseliflavus (n=4, 2%). A total of 25 (12.5%) isolates were HLGR, 13 (6.5%) isolates were HLSR and 62 (31%) isolates were HLGR+HLSR. Vancomycin resistance was found in 14 (7%) isolates of which 11 (78.5%) were Van A and 3 (21.4%) were Van B, detected phenotypically as per relative MIC of vancomycin and teicoplanin. Linezolid resistance was seen in 4 (2%) of isolates which were vancomycin as well as high-level gentamycin and high-level streptomycin resistant. Conclusion: Isolation of Enterococcus species resistant to most of the higher antibiotics like vancomycin and linezolid, with high prevalence of High-Level Aminoglycoside Resistance (HLAR), from hospitalized patients is a major concern as such isolates have limited or no therapeutic option.

Introduction: Chronic Suppurative Otitis Media (CSOM) still is a common health care problem in developing countries like India with its potential for serious local damage and complications. Knowledge of causative microorganisms and their antimicrobial sensitivity pattern is essential so that early and effective therapeutic measures can be initiated for better patient outcome. Aim: The study was carried out to determine the clinicomicrobiological spectrum of CSOM from this geographical area and to evaluate the susceptibility pattern of aerobic bacterial isolates. Materials and Methods: The prospective study was carried out for a period of one year from December 2013 to November 2014 in Chhatrapati Shivaji Subharti Hospital, a Tertiary Care Hospital in Meerut city. A total of 113 ear discharge was collected from clinically suspected cases of CSOM. The discharge was cultured on blood agar and Mac Conkey’s agar plates for isolation of bacterial pathogen and Sabourauds Dextrose Agar (SDA) slants for isolation of fungal pathogens. Identification of the bacterial and fungal isolates was done using standard bacteriological and mycological methods respectively. Antimicrobial susceptibility testing of the bacterial isolates was performed by Kirby-Bauer’s disc diffusion method as per the Clinical Laboratory Standards Institute (CLSI) guidelines. Further, detection of Metallo Beta Lactamase (MBL) production, Methicillin Resistance in Staphylococcus aureus (MRSA) and Extended Spectrum Beta –Lactamase (ESBL) production was carried out by phenotypic methods. Result: A total of 73.45% cases were culture positive. Pure bacterial pathogen was isolated from 67.46 % followed by pure fungal pathogen 22.89% and mixed pathogen (bacteria and fungus) from 9.63% of cases. Pseudomonas aeruginosa and Staphylococcus aureus were the predominant bacterial pathogen and Aspergillus spp. and Candida species were the predominant fungal pathogens isolated. Overall the rate of MBL producers, MRSA and ESBL producers were 18.18%, 52.94% and 62.5% respectively. Conclusion: High level of resistance was observed in cases of CSOM from our hospital. Therefore, knowledge of the causative microorganisms and its susceptibility pattern is required and this data may contribute to an effective management of cases of CSOM.

There is a paucity of health policy relevant data for chronic liver disease from India, impeding formulation of an interventional strategy to address the issue. A prospective, multicentric study to delineate the etiology and clinical profile of chronic liver disease in India is reported here. A centrally coordinated and monitored web-based data repository was developed (Feb, 2010 to Jan, 2013) and analyzed. Eleven hospitals from different parts of India participated. Data were uploaded into a web based proforma and monitored by a single centre according to a standardized protocol. 1.28% (n = 266621) of all patients (n = 20701383) attending the eleven participating hospitals of India had liver disease. 65807 (24·68%) were diagnosed for the first time (new cases). Of these, 13014 (19·77%, median age 43 years, 73% males) cases of chronic liver disease were finally analyzed. 33.9% presented with decompensated cirrhosis. Alcoholism (34·3% of 4413) was the commonest cause of cirrhosis while Hepatitis B (33·3%) was predominant cause of chronic liver disease in general and non-cirrhotic chronic liver disease (40·8% out of 8163). There was significant interregional differences (hepatitis C in North, hepatitis B in East and South, alcohol in North-east, Non-alcoholic Fatty Liver Disease in West) in the predominant cause of chronic liver disease. Hepatitis B (46·8% of 438 cases) was the commonest cause of hepatocellular Cancer.11·7% had diabetes. Observations of our study will help guide a contextually relevant liver care policy for India and could serve as a framework for similar endeavor in other developing countries as well.

In a developing country like India, where the patients have to bear the cost of their healthcare, the microbiological culture and the sensitivity testing of each and every infection is not feasible. Moreover, there are lacunae in the data storage, management and the sharing of knowledge with respect to the microorganisms which are prevalent in the local geographical area and with respect to the antibiotics which are effective against them. Thus, an empirical therapy for treating infections is imperative in such a setting. The beta lactam antibiotics have been widely used for the empirical treatment of infections since the the discovery of penicillin. Many generations of beta lactams have been launched with, the claims of a higher sensitivity and less resistance, but their sensitivity has drastically decreased over time. Thus, the preference for beta lactams, especially the cephalosporins, as an empirical therapy, among the prescribers was justified initially, but the current sensitivity patterns do not support their empirical use in hospital and community acquired infections. There is a need for increasing the awareness and the attitudinal change among the prescribers, screening of the antibiotic prescriptions, the strict implementation of antibiotic policies in hospital settings, restricting the hospital supplies and avoiding the prescriptions of beta lactams, a regular census of the local sensitivity patterns to formulate and update the antibiotic policies, upgradation of the laboratory facilities for a better and faster detection of the isolates, proper collection, analyses and sharing of the data and the encouragement of the research and development of newer antibiotics with novel mechanisms of action.

Background: AmpC beta lactamases are cephalosporinases that confer resistance to a wide range of beta lactam drugs thereby causing serious therapeautic problem. As there are no CLSI guidelines for detection of AmpC mediated resistance in Gram negative clinical isolates and it may pose a problem due to misleading results, especially so in phenotypic tests. Although cefoxitin resistance is used as a screening test, it does not reliably indicate AmpC production. Materials and Methods: We planned a study to determine the occurrence of AmpC beta lactamase in hospital and community, clinical isolates of Escherichia coli and simultaneously evaluate different phenotypic methods for detection of AmpC beta lactamases. Results: It was observed that 82.76% isolates were ESBL positive and 59% were cefoxitin screen positive. Using phenotypic confirmatory tests the occurrence of Amp C beta lactamases was found to be 40% and 39% by inhibitor based method using boronic acid (IBM) and modified three dimensional test (M3D) respectively. Conclusion: Both the test showed concordant result. Co-production was observed in 84.62% isolates Screening of ESBL and Amp C can be done in routine clinical microbiology laboratory using aztreonam and IBM respectively as it is a simple, rapid and technically less demanding procedure which can be used in all clinical laboratories.

Background: Ventilator-associated pneumonia (VAP) is the most common cause of hospital acquired infection and death among patients admitted in ICU. Microorganisms responsible for VAP vary from place to place. Gram-negative bacteria (GNB) have emerged as a major group of pathogen causing VAP and over the years carbapenem group of antibiotics has emerged as one of the important antibiotics used in the critically ill patients. There have been reports of increased occurrence of infection by carbapenem-resistant bacteria in health care settings in recent times. Aim: The aim of the study was to assess the incidence of VAP, their microbiological profile with reference to carbapenemase producing GNB in the intensive care unit of a tertiary care hospital, their relation to initial emperical antibiotic therapy, sensitivity patterns, and outcome. Materials and Methods: This prospective study was carried out over the period of 1 year (July 2010-June 2011) on 100 randomly selected patients above the age of 18 years admitted in the emergency/ICU and requiring intubation and mechanical ventilation for more than 72 hours. The diagnosis of VAP was established on the basis of clinical and radiological parameters as per Centre of Disease Centres (CDC) guidelines. A baseline sample was obtained after initial endotracheal intubation. Thereafter, the culture sent on the first day of occurrence of clinical sign of VAP. Culture was done on blood agar and MacConkey agar. All imipenem-resistant strains were further confirmed by Modified Hodge test and combined disc for confirmation of respective carbapenemase. Results: Incidence of VAP was found to be 51%. GNB mainly Citrobacter 28 (52.83%) and Klebsiella pneumoniae 7 (13.21%), were the most commonly isolated pathogens. The prevalence of carbapenemase-producing GNB was alarmingly high 24/50 (48%). The entire carbapenemase producers showed high degree of cross resistance to antibiotics with some sensitivity to Polymyxin B (94 %) and Tigecycline (96%) Conclusion: High incidence of VAP and the potential carbapenemase-producing GNB are real threat in our ICU. The emergence of microorganisms known for its inherent resistance among most of the common first-line antibiotics calls for a alarm in all upcoming tertiary care hospitals.

Background: Vancomycin may be ineffective against an increasing proportion of methicillin resistant Staphylococcus aureus (MRSA) with minimum inhibitory concentrations (MICs) well within the susceptible range. On the other hand it is common knowledge that determination of vancomycin MICs is method dependent. Therefore, given the apparent variability in vancomycin MIC results obtained with the different methods, the use of the vancomycin MIC to predict the outcome of serious S. aureus infections needs to take into account the method used and the results of studies using that particular method. Aim: Comparative study was carried out to evaluate the MICs obtained by BMD method, E-test, and Vitek 2 method and to detect inconsistencies in these vancomycin for 66 MRSA isolates obtained from various samples of patients attending the OPDs & IPDs within a period of one year. Materials and Methods: A comparative study was carried out to evaluate the MICs obtained by BMD method, E-test, and Vitek 2 method to detect vancomycin susceptibility in 66 clinical isolates of MRSA obtained from various samples of patients attending the OPDs & IPDs within a period of one year. The study was conducted in Department of Microbiology, Subharti Medical College, Meerut from January to December 2012. Results: On determination of MICs for vancomycin for the MRSA isolates, all were identified as VSSA by BMD, E-Test & Vitek 2 methods. However, the vancomycin MIC values obtained by E-test correlated better with BMD method (correlation factor= 0.6727) than Vitek 2 (correlation factor=0.5316), indicating E-Test to be a better method for determination of vancomycin MICs as compared to Vitek 2. Conclusion: MRSA isolates with higher vancomycin MICs, even within the susceptibility range, are being observed more frequently which result in treatment failures with vancomycin. Because of the discrepancy that exists in vancomycin MIC results from different methods, the prediction of outcome of serious S.aureus infections should take into account the method used & results of studies using that particular method.

Introduction: In view of the increasing prevalence of invasive Candidiasis in today’s health-care scenario and the emergence of fluconazole resistance among clinical isolates of Candida, we sought to determine if Ibuprofen could elicit a reversal of fluconazole resistance and thereby offer a potential therapeutic breakthrough in fluconazole-resistant Candidiasis. Materials and Methods: We selected 69 clinical isolates of Candida, which demonstrated an MIC of >32 µg/ml for fluconazole, and subjected them to broth microdilution in presence and absence of Ibuprofen. Results: Forty two of the 69 isolates (60.9%) demonstrated reversal of Fluconazole resistance with concomitant use of Ibuprofen. This was characterized by significant species-wise variation (p=0.00008), with all the C. albicans isolates and none of the C. glabrata isolates demonstrating such reversal. Only 22.2% and 37.7% of C. krusei and C. tropicalis isolates respectively showed Ibuprofen-mediated reversal of Fluconazole resistance. Conclusion: Since Ibuprofen is a known efflux pump inhibitor, our findings hint at the possible mechanism of Fluconazole resistance in most of our Candida isolates and suggest a potential therapeutic alternative that could be useful in the majority of Fluconazole-resistant clinical isolates of Candida.

Background: Breast carcinoma is the common malignant lesion in women. Fine needle aspiration cytology has high sensitivity and specificity and is simple, rapid and safe method to diagnose breast lesions. Materials and methods: A retrospective study was done in department of pathology of C.U.SHAH medical college and hospital of Surendranagar from January 2010 to July 2012. Total 120 FNAC of palpable breast lump was done in pathology department of C.U. SHAH medical college and hospital and correlate it with histopathological findings. All cases are categorized according to risk for cancer into unsatisfactory sample, benign proliferative breast disease without atypia, Benign proliferative disease with atypia, Inflammatory breast disease, suspicious for malignancy and malignant lesions. Results: Out of 120 cases, 65 cases were benign, 32 malignant, 2 suspicious and 16 were inflammatory breast and 4 were unsatisfactory lesions. Cytological and histopathological correlation found in 114 cases (95.83%) out of 120 cases. Fibroadenoma is the most common benign breast lesion noted in 21-30 years age group, while ductal carcinoma was commonest malignant lesion noted in 41-50 years of age group. The sensitivity and specificity of FNAC were 97.05% and 98.78% Conclusion: Fine needle aspiration cytology of palpable breast lesions is an effective modality for diagnosis of most of the malignant and benign lesions. Fine Needle Aspiration Cytology is highly sensitive and specific technique for diagnosis of most of the malignant and benign breast lesions.

A telemedicine system is described for monitoring vital signs and general health indicators of patients with cardiac and diabetic conditions. Telemetry from wireless sensors and readings from other instruments are combined into a comprehensive set of measured patient parameters. Using a combination of mobile device applications and web browser, the data can be stored, accessed, and displayed using mobile internet communications to the central server. As an extra layer of security in the data transmission, information embedded in the data is used in its verification. The paper highlights features that could be enhanced from previous systems by using alternative components or methods.