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Antimicrobial resistance (AMR) is a major public health problem in India. We surveyed medical students to assess their knowledge, attitudes, and factors associated with confidence in antibiotic prescribing intent. In this cross-sectional study, a convenience sample of 356 students were surveyed in July–August 2017 on AMR-related knowledge, attitudes, information sources and antimicrobial training. Antimicrobial resistance knowledge and attitude scores were calculated. Bivariate analysis using the chi-square test of independence and multivariate binary logistic regression analysis were used to investigate factors associated with confidence in antibiotic prescribing intent. A total of 347 students completed the survey; 64% agreed that strong knowledge of antibiotics is important in their medical careers; 61% stated that they would like more education regarding appropriate use of antibiotics. The mean total knowledge score was 11.5 out of 31 (SD = 3.4), and the mean attitude score was 6.0 out of 16 (SD = 4.2). Although 13% of students were “very familiar”/“familiar” with the term “antimicrobial stewardship,” only 35% of students felt “very confident” or “confident” in antimicrobial prescribing to patients in the future. On multivariate analysis, female gender, clinical vignette antimicrobial knowledge scores, positive attitude scores, awareness of Infection Control Policy, and > 3 years of antimicrobial prescribing clinical training were predictors of confidence in antimicrobial prescribing. A higher attitude score was independently associated with decreased confidence in antimicrobial prescribing intent. There is a need to improve education regarding AMR in the curriculum, and increase awareness of infection control policies and antimicrobial stewardship program in clinical settings.

Zika virus (ZIKV) infection is a public health problem in the Americas. We assessed ZIKV knowledge, attitudes, and future ZIKV vaccine intent among medical students. In this cross-sectional study, a convenience sample of medical students in San José, Costa Rica, were surveyed to assess knowledge, attitudes, vaccine intent, and sources of information about ZIKV. Knowledge and attitude scores were calculated. Factors associated with vaccine intent were determined by bivariate analysis using a chi-square test. Of 468 participants surveyed, majority were females (299, 63.8%) and lived in urban areas (411, 87%). The participant mean knowledge score was 12.2 (SD: 3.65) out of a possible 20. Students residing in suburban or rural areas (odds ratio [OR]: 0.432; CI: 0.24–0.78), first- or second-year students (OR: 0.423; CI: 0.27–0.67), and aged < 20 years (OR: 0.586; CI: 0.36–0.97) had significantly lower knowledge scores. The participant mean attitude score was 30.2 (SD: 4.76) on a scale of 13–65, with lower numbers indicating a concern for ZIKV severity. A majority of the participants indicated they would be likely or extremely likely to receive a ZIKV vaccine (420, 89.7%) and recommend the vaccine to their patients (439, 93.8%). Vaccine intent was not influenced by demographics, total knowledge, and attitude scores. Students (388, 83%) identified the Internet as their primary source of ZIKV information. A majority of students demonstrated a positive attitude toward ZIKV and willingness to accept and recommend a vaccine. Low knowledge scores underscore the need for ZIKV education, especially in the early years of medical school. Use of the Internet should be considered in dissemination of ZIKV education.

Chronic hepatitis B virus (HBV) infection is a major public health problem in China. We evaluated the impact of psychosocial factors (stigma, disclosure, depression, and anxiety) on health-related quality of life (HRQoL) among people living with chronic HBV infection (CHB) in the city of Dalian, Liaoning Province, China. In this hospital-based cross-sectional study, 401 patients living with chronic HBV infection were enrolled as study participants. Study measures included the Beck depression and anxiety inventory, the WHO Quality of Life (WHOQOL-BREF) assessment, the Toronto Chinese HBV Stigma Scale, and disclosure of HBV status to sexual partners. The primary outcome was HRQoL score as measured by the WHOQOL-BREF. A linear regression model was used to examine the association between HRQoL and the potential risk factors including stigma, disclosure, depression, anxiety, and sociodemographic variables. Stigma, disclosure, depression, and anxiety were the covariates of interest. A majority of the participants were females (n = 251, 65.6%), married (81.6%), and had a college or higher degree (32.4%). Depression, anxiety, stigma, and disclosure of HBV infection were associated with low HRQoL in all four domains of the WHOQOL-BREF (physical, psychological, social, and environmental domains) (P < 0.05), when all psychological factors were included in the model separately. Depression was found to be independently associated with low HRQoL in people living with HBV, when all psychological factors were included in the model simultaneously (P < 0.0001). Our data indicate the urgent need for healthcare providers (HCPs) and policy-makers to implement psychological interventions to improve HRQoL among people living with CHB.

Objective: Safe and effective human papillomavirus vaccines are available against cervical cancer and other human papillomavirus–associated diseases. Vaccine uptake is low in India given lack of universal vaccination programme. This exploratory study describes the medical, dental and nursing undergraduate student perspectives about human papillomavirus and intentions to receive the vaccine. Methods: Using a cross-sectional, explorative study design, we conducted two focus group discussions among a convenience sample of male (n = 11) and female (n = 9) student group aged ⩾18 years, respectively, at a medical college in South India. The focus group discussion sessions were recorded, transcribed and analysed using thematic content analysis. Results: Over half of the students showed adequate knowledge of cervical cancer and human papillomavirus. Medical students had much in-depth knowledge of cervical cancer, vaccine cost and its side effects compared to dental and nursing students. Human papillomavirus vaccine knowledge was relatively less among males compared to females; most male participants were unaware of the availability of the human papillomavirus vaccine. Intention to receive the vaccine was higher among females than males. All the participants had positive attitude in creating awareness in the community and making the vaccine cost-effective. Cultural concerns and high vaccine cost were cited major barriers for vaccine uptake. Suggestion of physician recommendation in promotion of human papillomavirus vaccine uptake was an emerging theme. Conclusion: Educating male students and those enrolled in dental and nursing courses about human papillomavirus vaccine, addressing cultural concerns and advocating provider recommendation for promoting vaccine uptake are potential strategies to improve future human papillomavirus vaccine intent among students and recommendations to patients in their role as future healthcare provider.

Cervical cancer is the second leading cause of cancer and one of the leading causes of cancer-related death in women in India. Human papillomavirus (HPV) vaccine uptake in India is low due to cost, low awareness of HPV, social stigma, and other factors. We assessed the awareness, attitudes, and beliefs regarding HPV and HPV vaccination and explored the barriers and challenges to HPV vaccine intent among women in Mangalore, India. An exploratory study was conducted using two focus group discussions (FGDs) and six in-depth one-on-one interviews. FGD-1 comprised nine women aged 18 to 26 years, and FGD-2 comprised seven women aged 27 to 45 years. The FGDs were recorded, transcribed, and analyzed using thematic content analysis. Themes identified were limited knowledge of HPV and vaccine, stigma associated with receiving HPV vaccine, vaccine safety concerns, and cost as a barrier to receiving vaccine. Participants expressed desire for physician and government recommendation of the HPV vaccine to validate vaccine intent. Contrasting themes between the two FGDs include support for vaccination at a younger age and lower perception of stigma and judgment in the 18- to 26-year-old group; however, participants in the 27- to 45-year-old group support vaccination at an older age and endorse greater fear of stigma and judgment associated with obtaining vaccination. Education regarding HPV-associated diseases and the HPV vaccine for the general public, physicians, and government officials in conjunction with lowering vaccine cost, improving vaccine access, and encouraging strong physician recommendations are key strategies to scale up HPV vaccine implementation in India.

This case highlights the need for accurate and rapid testing for SARS-CoV-2 and also underscores the need for caregivers to remain vigilant for COVID-19 in the post-operative setting despite negative pre-operative testing.

Background: Children with disabilities are expected to have poor nutritional status in comparison to children without disabilities. However, limited data on nutritional status of children with and without disabilities in rural settings in India. Objective: To assess and compare the nutritional status of children with and without disability. Methods: A cross-sectional study among children aged 5–15 years was conducted in the rural practise area of a medical college in Karnataka. 290 children (145 with and 145 children without disability) of similar age and sex were studied. Age and sex-specific World Health Organization (WHO) BMI centiles, 24 h dietary calorie and protein intakes were assessed and compared. Median and interquartile ranges were calculated for quantitative variables. Mann–Whitney U test was used to assess the differences in quantitative variables among the two groups. Results: As per WHO BMI centiles, 33.1% with and 37.20% without disabilities were undernourished. The median calorie consumed by children with disabilities was 1169.0 (946.5–1586.0) significantly lower compared to that of children without disability, that is, 1362.0 (1167.0–1641.0). The median protein consumed by children with disabilities was 28.0 (22.5–38.0) significantly lower compared to that of children without disability, that is, 32.0 (28.0–40.0). Conclusions: Children with disabilities had similar rates of undernutrition as that of their non-disabled peers and their lesser dietary intake in terms of calories and proteins.

Introduction: Community Acquired Pneumonia (CAP) is associated with high morbidity and mortality worldwide. Knowledge of common microbial patterns in CAP is crucial for making initial therapeutic decisions for empiric antimicrobial treatment. Aim: To determine the bacterial aetiology of CAP among hospitalised patients in a tertiary care hospital of Southern India. Materials and Methods: A descriptive study was carried out among 220 adult subjects, enrolled from a period of August 2012 to August 2014, admitted to a tertiary care hospital of Southern India, with a provisional diagnosis of CAP. Subjects were recruited based on chest radiography and clinical criteria. Blood, sputum, pleural fluid, Bronchoalveolar Lavage (BAL) and tracheal aspirates were obtained for microbiological investigations. Antimicrobial susceptibility testing was carried out on Streptococcus pneumoniae and Staphylococcus aureus isolates. The clinical specimens were further subjected to Polymerase Chain Reaction (PCR) to confirm the bacterial aetiology of S.pneumoniae and Haemophilus influenzae. Study data were summarised by frequency and percentage using SPSS (Statistical Package for Social Sciences) version 16.0. Results: A total of 220 subjects who were diagnosed for CAP of which 154 (70%) were culture negative and 66 (30%) were culture positive cases of CAP. The most commonly isolated pathogens were 29 (44%) of S.pneumoniae followed by 21 (32%) of S.aureus, 10 (15%) of H.influenzae and 6 (9%) of Klebsiella pneumoniae. Resistance to penicillin occurred in 24 (82.75%) of S.pneumoniae isolates. Methicillin-Resistant Staphylococcus aureus (MRSA) was demonstrated among 10 (48%) of the 21 total S.aureus CAP cases. Conclusion: Culture-based aetiologic diagnosis of CAP was made in only one-third of the cases. Ongoing antimicrobial resistance surveillance to S.pneumoniae and S. aureus is recommended. Determining the resistance profile of Klebsiella pneumoniae and H.influenzae is needed as pneumonia caused due to Gram negative aetiology is rising in the community setting. Rapid screening of bacterial CAP pathogens from clinical samples using PCR may be beneficial for clinicians to make a prudent antibiotic choice for CAP.

Late presentation to healthcare by HIV infected patients’ is common in India despite access to free combination antiretroviral therapy (cART). We assessed risk factors for late presentation among patients with a recent HIV diagnosis in an academic university–based antiretroviral treatment center. This retrospective study included 474 recently diagnosed HIV-infected patients registered for cART between 2012 and 2013. Subjects with CD4(+) T-lymphocyte (CD4) count ≤ 350 cells/μL or with an AIDS defining event were defined as late presenters (LP) and patients with CD4 count ≤ 200 cells/μL or with an AIDS defining event were defined as LP with advanced HIV disease (LPAD). Multivariable logistic regression analysis was used to investigate factors associated with late presentation. Of the 474 patients, 356 (75.1%) were LP. Of these, 299 (83.99%) were LPAD and 57 (16.01%) LP were AIDS-free. Median CD4 count among LP was 134 cells/μL (interquartile range 72.25–219). Mean age of LP was 42.50 ± 8.88 years; 256 (71.9%) were males. Increasing age (> 51 years; Adjusted odds ratio [aOR] 4.19; P = 0.014) and rural residence (aOR 3.19; P = < 0.001) were independently associated with late presentation. HIV-positive housewives (aOR 0.34; P = 0.027), HIV-positive individuals with negative partners (aOR 0.48; P = 0.006), and partners with unknown HIV status (aOR 0.43; P = 0.007) were less likely to present late compared with positive partners of people living with HIV/AIDS (PLWHA). Most patients were LP despite free access to cART. Rural population and older PLWHA should be targeted while implementing HIV care. There is a need to strengthen the HIV care cascade by linking PLWHA to cART immediately after diagnosis.

Background: Antibiotic overuse is a major public health challenge worldwide. Data from India related to physician antibiotic prescribing patterns are limited. Aims: We assessed antibiotic prescribing knowledge, attitudes, and practices among physicians in Mangalore, South India. Materials and Methods: Using a cross-sectional descriptive study design, physicians at academic tertiary hospitals completed an anonymous on-site survey. The survey items incorporated Likert scales, and data were analyzed using SPSS version 15.0. Results: Of the 350 physicians approached using a convenient sampling method, 230 (66%) consented and interviewed. The physician's knowledge of resistance patterns of common bacteria was related to receiving periodic updates on resistance patterns of bacteria (P = 0.019) and participation in courses on antibiotics (P = 0.026). Individuals with more number of years of experience (mean of 11 years) were less likely to justify antibiotic use for uncomplicated bronchitis (P = 0.015) and acute gastroenteritis (P = 0.001). Most respondents (n = 204, 89%) believed that physicians overprescribed antibiotics in routine clinical practice. Forty-five percent (n = 104) stated that their hospitals did not have an infection control policy in place. Conclusions: This study provides some understanding of physician's antibiotic prescribing patterns from teaching hospitals in India. Judicious antimicrobial use through educational and antimicrobial stewardship programs remains critical to control the spread of antibiotic resistance.

Key Clinical Message The diagnostic utility of fine needle aspiration cytology to detect a wide variety of opportunistic pulmonary infections in an immunocompromised host has been studied. Fine needle aspiration cytology techniques are safer, cost‐effective and provide rapid results.

In recent years, there has been a substantial increase in refugee and asylum-seeking adults, adolescents and children to high-income countries. Infectious diseases remain the most frequently identified medical diagnosis among U.S.-bound refugee children. Medical screening and immunization are key strategies to reduce the risk of infectious diseases in refugee, internationally adopted, and immigrant children. Notable infectious diseases affecting refugee and other newly arriving migrants include latent or active tuberculosis, human immunodeficiency virus type 1 (HIV), hepatitis B, hepatitis C, vaccine-preventable diseases, malaria, and other parasitic infections. The U.S. Centers for Disease Control and Prevention and the American Academy of Pediatrics have published guidelines for health assessment of newly arriving immigrant, refugee, and internationally adopted children. Although, data on the health risks and needs of refugee exists in some high-income countries, there is an urgent need to develop robust evidence-informed guidance on screening for infectious diseases and vaccination strategies on a broader scale to inform national policies. Innovative approaches to reach migrant communities in the host nations, address health and other complex barriers to improve access to high-quality integrated health services, and strong advocacy to mobilize resources to improve health, safety, and wellbeing for refugee children and their families are urgent priorities.

Purpose: To evaluate knowledge, attitudes and factors associated with acceptability of human papillomavirus (HPV) vaccine among undergraduate medical, dental, and nursing students in South India. Methods: Using a post-test study design, a convenience sample of 988 students (age 18–26 years) were surveyed. The primary outcome was vaccine acceptability (likely to intend to receive the vaccine). Bivariate analysis using Chi-Square test of independence and multivariate binary logistic regression analysis was used to examine factors associated with vaccine acceptability. Results: Out of 988 students surveyed, majority had heard about cervical cancer (95%), HPV (89.3) or genital warts(77.5). Only 59.7% had heard of HPV vaccine prior to the survey; 65.2% intended to receive the vaccine and 68.3% were willing to recommend the vaccine to others. Participants aged

Background: The epidemiology of acute hematogenous osteomyelitis (AHO) in children has changed. Methods: We reviewed the current literature regarding the epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, and antimicrobial management of AHO in children. Results:Staphylococcus aureus is the most common microorganism causing pediatric AHO, followed by group A Streptococcus (GAS). AHO due to community-associated methicillin-resistant Staphylococcus aureus (MRSA) can cause severe and complicated disease. Pathogen isolation by culture is key for targeted antibiotic therapy. Polymerase chain reaction assay in tissue sample or joint fluid may enhance the yield of Kingella kingae. C-reactive protein is useful in diagnosis and monitoring the course of AHO. Magnetic resonance imaging is the preferred diagnostic imaging study for AHO. Clindamycin or vancomycin (for serious disease) is recommended for empiric therapy of suspected AHO due to MRSA depending on the geographic prevalence. Penicillinase-stable penicillins or first-generation cephalosporins are preferred antibiotics to treat methicillin-sensitive S aureus (MSSA) infection. Beta-lactam agents are the drugs of choice for treating AHO due to K kingae, GAS, or Streptococcus pneumoniae. For uncomplicated AHO due to MSSA, a short parenteral antibiotic course followed by oral therapy for a minimum total duration of 3-4 weeks is adequate. Complicated AHO due to MRSA may warrant prolonged therapy with surgical intervention. Conclusion: Given the evolution of pathogens, the variability in clinical presentations and course ranging from simple to complex disease, and response to treatment, the management of AHO continues to evolve and warrants an individualized, multidisciplinary approach.

Acute appendicitis is a common disease afflicting the pediatric population. There are textbook presentations of periumbilical abdominal pain that migrates to the right lower quadrant with following nausea, possible diarrhea, anorexia, fever and eventual sepsis. The abnormal presentations are difficult to sort at times and varying presentations have been noted. The differential should remain broad in evaluating patients as our case illustrates. Keywords: Acute appendicitis, Amyand hernia, Scrotal abscess

Introduction: Malnutrition is a leading cause of childhood mortality and morbidity. It is a silent emergency which results from combination of factors and conditions. Growing children are most vulnerable to its consequences. Aim: To determine the prevalence of malnutrition among preschool children in Karnataka. Materials and Methods: A systematic review and meta-analysis was done to find out the pooled estimation of prevalence of malnutrition. An extensive literature search of International and National electronic databases were carried out. The criteria used for the search were limited to descriptive studies, cross- sectional studies, and epidemiological studies in English language. Out of 2183 studies, 28 papers were assessed for methodological quality and finally 24 papers were included in the review based on the inclusion and exclusion criteria. These studies were then subjected to quality of assessment using the STROBE guidelines. Results: Out of 24 articles, 19 articles were graded prevalence of malnutrition as per New WHO 2006 child growth standards and five studies were graded malnutrition as per IAP classification. The pooled prevalence of malnutrition as per IAP classification was 41% with 95% CI (0.23- 0.59). The pooled prevalence of underweight as per WHO child growth standard was 44% with 95% CI (0.38–0.49), stunting 35% with 95% CI (0.31-0.40), and wasting 28% with 95% CI (0.17–0.38). Conclusion: The findings of this review indicate that malnutrition is still an important problem in children. There is a need for finding the risk factors for malnutrition and a consistent effort from departments and parents concerned to improve the nutritional status further to reduce morbidity among children.

Fine needle aspiration cytology (FNAC) can be quite helpful in distinguishing malignancy from infection. Fungal elements may be detected using routine stains as in our case. The present case describes a 64-year-old male presented with chills and mild dyspnea on exertion after completing four cycles of chemotherapy for stage IIA adenocarcinoma of the lung. Use of special stains to enhance cytomorphological changes in conjunction with microbiology culture results is critical to identify the specific microorganism.

Background Extended-spectrum β-lactamase is a major public health problem in hospitals and community that mediate resistance to Penicillin, Cephalosporins, and Monobactams. Data regarding the detection of TEM, CTX-M, and SHV genes by molecular techniques and typing by RAPD in ESBL producing bacteria can be useful in epidemiology and risk factors associated with infections. Methods Total of 140 samples were collected. Well water (n = 50), Fish effluents (n = 40), and Diarrheal stool samples (n = 80). Antibiotic susceptibility test was done using the Kirby–Bauer disc diffusion method. Phenotypic detection of ESBL enzyme was done by Double disk diffusion test. PCR analysis was carried out for β-lactamase genes TEM, SHV, and CTX-M. Molecular Typing was done by RAPD. Results 38 (57.57%) Klebsiella spp. isolated from Fish Effluents,11 (57.89%) from Well water and 15 (18.98%) from Diarrheal stool samples. ESBL producers were 4 (26.66%) from stool and 12 (31.57%) from fish effluents. Stool isolates showed high resistance to Ampicillin (86.7%), Cefuroxime (83.3%), Cefepime (76.7%), and Ceftazidime (70%). Fish effluents were more resistant to Cefeperazone sulbactum (95.9%), Ampicillin (81.6%) while well water isolates showed high resistance to Ampicillin (94.7%) and Erythromycin (73.7%). Molecular identification showed the presence of more than 2 genes among the isolates. Prevalence of gene bla- TEM was highest, followed by bla-CTX-M and bla-SHV. Genetic relatedness are expressed as percentage similarity and presented as dendogram. Conclusion The study shows high prevalence of ESBL among Klebsiella isolates mainly rom Fish effluents and diarrheal stool samples. It shows 24% ESBL positive rate. Antibiotic-resistant bacteria from fish effluents highlights the associated human health risk when they enter food chain and become passive carriers. Practice of routine ESBL testing with conventional antibiotic susceptibility testing would be useful for combatting multi drug resistance.Present study shows high prevalence of TEM gene among Klebsiella species. RAPD-PCR will help in descriminating isolates and reflecting the genotypes circulating in the settings either hospital or in community. Disclosures All authors: No reported disclosures.

Invasive pneumococcal disease (IPD) is a major cause of pediatric morbidity and mortality in resource-rich and low and middle-income countries (LMICs). Streptococcus pneumoniae can cause a wide spectrum of invasive and non-invasive disease. In resource-rich countries, implementation of 7-valent pneumococcal conjugate vaccine (PCV7) has been a significant public health achievement. Dramatic decrease in pediatric IPD incidence occurred after PCV7 implementation, but emergence of multi-drug-resistant non-vaccine serotypes (especially 19A) remains a concern. The recently introduced 13-valent PCV (PCV13) has the potential to further reduce the burden of IPD due to serotypes not contained in PCV7. Given the diversity of pneumococcal serotypes and the possibility of serotype replacement disease, innovative approaches to development of pneumococcal vaccines are needed. Continued surveillance of pneumococcal serotypes and antimicrobial resistance is crucial to evaluate the impact of PCV13 vaccine. Improved access to PCVs is crucial to reduce morbidity and mortality related to IPD in LMIC.

Background: The counselors’ form the backbone of HIV/AIDS control program, and for voluntary counseling and testing services to be effective counselors’ opinions are crucial. Purpose: To assess the perceptions of integrated counseling and testing center (ICTC) counselors with respect to the training received, problems faced in providing services, and job satisfaction. Methods: Qualitative methods such as 1 focus group discussion and 7 in-depth interviews were conducted among 14 counselors employed at 13 ICTCs in a costal district of south India. Results: The counselors identified the need for improving refresher training; job perception and satisfaction among counselors was found to be poor; issues such as shared confidentiality and targets for counseling were perceived to affect the ICTC services. Conclusion: The issues identified by counselors such as problems related to refresher training, targets set for counseling and testing, the pay scale and shared confidentiality should be addressed for better service delivery.

Background. With prolonged replication, attenuated polioviruses used in oral polio vaccine (OPV) can mutate into vaccine-derived poliovirus (VDPV) and cause poliomyelitis outbreaks. Individuals with primary humoral immunodeficiencies can become chronically infected with vaccine poliovirus, allowing it to mutate into immunodeficiency-associated VDPV (iVDPV). It is unclear if children perinatally infected with the human immunodeficiency virus (HIV), who have humoral as well as cellular immunodeficiencies, might be sources of iVDPV. Methods. We conducted a prospective study collecting stool and blood samples at multiple time points from Zimbabwean infants receiving OPV according to the national schedule. Nucleic acid extracted from stool was analyzed by real-time polymerase chain reaction for OPV serotypes. Results. We analyzed 825 stool samples: 285 samples from 92 HIV-infected children and 540 from 251 HIV-uninfected children. Poliovirus shedding was similar after 0–2 OPV doses but significantly higher in the HIVinfected versus uninfected children after ≥3 OPV doses, particularly within 42 days of an OPV dose, independent of seroconversion status. HIV infection was not associated with prolonged or persistent poliovirus shedding. HIV infection was associated with significantly lower polio seroconversion rates. Conclusions. HIV infection is associated with decreased mucosal and humoral immune responses to OPV but not the prolonged viral shedding required to form iVDPV.

Influenza virus infection is a major cause of morbidity and mortality in children and adults globally. Seasonal epidemics are common due to the rapid virus evolution, whereas the frequent emergence of antigenic variants can result in pandemics and sporadic/endemic avian influenza virus infections. Although annual vaccination is the mainstay for influenza prevention and control, the use of antiviral agents must be considered for treatment and prophylaxis against influenza. Currently available antiviral drugs include neuraminidase inhibitors (NAIs), adamantanes, and a novel polymerase inhibitor (favipiravir). Peramivir is a recently US Food and Drug Administration-approved NAI for the treatment of acute uncomplicated influenza in adults. The chemical structure of peramivir allows it to bind to the influenza neuraminidase with much higher affinity than oseltamivir. Peramivir is effective against a variety of influenza A and B subtypes and has a lower half-maximal inhibitory concentration compared to other NAIs in in vitro studies. Peramivir can be administered intravenously, a route that is favorable for hospitalized, critically ill patients with influenza. The long half-life of peramivir allows for once-daily dosing. The drug is eliminated primarily by the kidneys, warranting dose adjustments in patients with renal dysfunction. Studies have assessed the clinical efficacy of peramivir for treatment of pandemic influenza A (H1N1). Although anecdotal evidence supports the use of peramivir in pediatric patients, pregnant women, and hospitalized patients with severe influenza receiving continuous renal replacement therapy and extracorporeal membrane oxygenation, well-designed, controlled clinical trials should be conducted in order to assess its clinical efficacy in these patient populations.

Introduction. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable degree with onset or recognition during pregnancy. As prevalence of diabetes is linked to impaired glucose tolerance during antenatal period, routine antenatal screening of GDM is required. However, screening tests for GDM remain controversial.Objective. To review different diagnostic criteria for GDM.Materials and Methods. Freely accessible, full-text articles from 1964 to 2015, available in PubMed in English language, pertaining to screening of GDM were reviewed.Results. First diagnostic criteria for GDM in 1964 by O’Sullivan and Mahan, modified by the National Diabetes Data Group (NDDG) in 1979 and Carpenter in 1982. The cut-off value as per WHO definition of GDM was 140 mg/dL, 2 hours after 75 g glucose intake. Diabetes in Pregnancy Study Group India (DIPSI), in 2006, endorsed WHO criteria but irrespective of the last meal timings. Being cost-effective, it formed the basis of national guidelines for Indians in 2014.Conclusions. As typical clinical scenarios are usually varied, practical guidelines that meet the constraints of low-resource settings like India are required.

Background: Client satisfaction is a good predictor of performance of health programs. Hence, clients’ perception and satisfaction studies provide insight to improve the program. Purpose: To assess clients’ perception and satisfaction with Integrated Counselling and Testing Centres (ICTCs) for HIV in an operational setting. Methods: A total of 191 client exit interviews from 12 ICTCs. The clients were stratified into general and antenatal clients. A systematic random sampling was done at high client load centers. Results: Cumulative client satisfaction was found to be 60% (±24%). Most of the clients (76%) agreed that counseling cleared doubts about HIV and found counseling beneficial (71%). Only 32% of the clients could recall issues discussed during the sessions. However, 92.5% were satisfied with ICTC facilities. Conclusions: Poor perception and low satisfaction with ICTCs needs to be addressed as this could have a direct bearing on the program.

Background: Diarrheal diseases are a major cause of morbidity and mortality in resource-limited countries. Among the bacterial pathogens, diarrheagenic E. coli (DEC) are most frequently implicated in cases of epidemic and endemic diarrhea worldwide. The objective of this study was to determine the prevalence of DEC in stool specimens from patients with acute diarrhea using polymerase chain reaction (PCR). Materials and Methods: Escherichia coli stool samples were collected from 115 hospitalized children and adults with acute diarrhea in Mangalore, a coastal city, in southern India. PCR amplification of eae, bfp, stx, ehx genes were used for detection of enteropathogenic (EPEC) and shigatoxigenic E. coli (STEC), lt and st genes were used for enterotoxigenic E. coli (ETEC) and astA gene for enteroaggregative E. coli (EAEC). Results: During the 24 month study period, of the 115 stool samples, DEC type was detected in 20 (17.4%) using the PCR method. The most prevalent DEC was atypical EPEC accounting for 12 (10.4%) cases followed by 4 cases of EAEC (3.4%) and 4 of STEC (3.4%). No ETEC strains were isolated from any of the examined stool samples. Conclusion: This study suggests that the atypical EPEC are the newly emerging group among DEC stains in Southern India. Further studies are needed to evaluate the epidemiology and virulence properties of atypical EPEC strains.

(See the editorial commentary by Jain et al, on pages 707–709.) Background. Peramivir, an investigational intravenous neuraminidase inhibitor in Phase 3 trials for hospitalized patients, was made available during the 2009 H1N1 influenza pandemic under the Emergency Investigational New Drug (eIND) regulations. We describe the clinical characteristics and outcomes of all patients for whom peramivir was requested under the eIND. Methods. After obtaining eIND approval from the Food and Drug Administration and local institutional review board approval, clinicians caring for hospitalized patients with influenza administered intravenous peramivir and collected information on demographic characteristics, clinical characteristics, and outcomes. Results. From April through October 2009, peramivir was requested for 42 patients and administered to 20 adults and 11 children. At hospitalization, all patients had rapidly progressing, radiographically confirmed viral pneumonia with respiratory failure, and all but 1 patient required mechanical ventilation. In most patients, including 1 person with documented oseltamivir-resistant infection, the illness had progressed despite oseltamivir treatment. Peramivir was administered for 1–14 days (median duration, 10 days). The 14-day, 28-day, and 56-day survival rates were 76.7%, 66.7%, and 59.0%, respectively. Peramivir was generally well tolerated. Conclusions. Intravenous peramivir was well tolerated and was associated with recovery in most patients hospitalized with severe 2009 H1N1 influenza viral pneumonia and treated under an eIND.

Background In China, chronic hepatitis B virus (HBV) infection is a major public health problem with ~6% of the population chronically infected. We investigated the effect of depression, anxiety, stigma, and disclosure on health-related quality of life (HRQoL) among people living with chronic HBV infection (CHB) in Dalian city, Liaoning, China. Methods Using a cross-sectional study design, 401 subjects with CHB were studied from January 2017 to September 2017. Study measures included Beck depression and anxiety inventory, WHOQOL-BREF, Toronto Chinese HBV Stigma Scale, and a questionnaire, which collected sociodemographic characteristic and disclosure of positive HIV status to sexual partners. The primary outcome was HRQoL score. A linear regression model examined the association between HRQoL and the potential risk factors including stigma, disclosure, depression, anxiety, and socio-demographic factors. Stigma, disclosure, depression, and anxiety are the covariates of interest. Age, sex, education, medical insurance, cirrhosis, other chronic diseases, and years of diagnose were adjusted in the model. Results Majority of participants were males (251, 62.59%). married (37.41%), and completed high and middle school (67%). Four factors of Depression, anxiety, stigma and disclosure had negative associated with QOL physical, psychological, social and environmental domains (P < 0.05) among CHB patients. Depression was the independent factor significant negative associated with HRQoL (P < 0.0001). Patients’ age had a significantly negative association with HRQOL in the psychological domain (P = 0.0083). Patients”education level had a significantly positive association with HRQOL for all four domains. Conclusion Our study is the first time to evaluate psychosocial factors affecting the HRQOL among people living with CHB in Dalian. Depression significantly affects the HRQOL among people living with CHB in Dalian, China warranting the urgent need for screening, early diagnosis, and implementation and integration of psychological interventions as part of routine care. Disclosures All authors: No reported disclosures.

Background Antimicrobial resistance (AMR) is a major public health problem in India. The World Health Organization recognizes that the education of medical students on antimicrobial stewardship plays a critical role in the efforts to combat AMR, but data related to knowledge, attitudes and practices (KAP) regarding AMR is limited in India. Methods This cross-sectional study was conducted in July-August 2017. Medical students at K.S. Hegde Medical Academy in Mangalore, India were surveyed with an anonymous questionnaire using a convenience sampling method involving second year, third year, fourth year, and intern students (n = 347). Data about demographics, sources of information, and antimicrobial training were collected. In addition, AMR knowledge and attitude scores were calculated. A Mann–Whitney U test was used to determine factors that were associated with significant differences in knowledge scores and attitude scores. The primary outcome measure of this study was to determine positive predictors of increased confidence in prescribing antimicrobials in the future using multivariate analysis. Results A total of 347 surveys were analyzed (response rate of 98.9%). The mean total knowledge score was 11.47 out to 31 with a standard deviation (SD) of 3.39, and the mean attitude score was 5.99 out of 16 (SD = 4.207). While 13.2% of students were “very familiar” or “familiar” with the term “Antimicrobial Stewardship,” and 88.2% of students said they would like more antimicrobial education in medical school. On multivariate analysis, female gender (OR 2.51, 95% CI (1.51, 4.18)), clinical vignette antimicrobial knowledge scores (OR 1.26, 95% CI (1.05, 1.51)), positive attitude scores (OR 0.94, 95% CI (0.88, 0.995)), awareness of Infection Control Policy (OR 1.87, 95% CI (1.09, 3.22)), and > 3 years of antimicrobial prescribing clinical training (OR 2.48, 95% CI (1.29, 4.75)) were predictors of confidence in antimicrobial prescribing. Conclusion This study identifies several possible interventions for improving confidence such as increased clinical knowledge through clinical experience, increased awareness of infection control policies and antimicrobial guidelines, and empowering students to be antimicrobial stewards to combat AMR. Disclosures All authors: No reported disclosures.

The concentration of human immunodeficiency virus type 1 (HIV-1) is generally lower in breast milk than in blood. Mastitis, or inflammation of the breast, is associated with increased levels of milk HIV-1 and risk of mother-to-child transmission through breastfeeding. We hypothesized that mastitis facilitates the passage of HIV-1 from blood into milk or stimulates virus production within the breast. HIV-1 env sequences were generated from single amplicons obtained from breast milk and blood samples in a cross-sectional study. Viral compartmentalization was evaluated using several statistical methods, including the Slatkin and Maddison (SM) test. Mastitis was defined as an elevated milk sodium (Na + ) concentration. The association between milk Na + and the pairwise genetic distance between milk and blood viral sequences was modeled using linear regression. HIV-1 was compartmentalized within milk by SM testing in 6/17 (35%) specimens obtained from 9 women, but all phylogenetic clades included viral sequences from milk and blood samples. Monotypic sequences were more prevalent in milk samples than in blood samples (22% versus 13%; P = 0.012), which accounted for half of the compartmentalization observed. Mastitis was not associated with compartmentalization by SM testing ( P = 0.621), but Na + was correlated with greater genetic distance between milk and blood HIV-1 populations ( P = 0.041). In conclusion, local production of HIV-1 within the breast is suggested by compartmentalization of virus and a higher prevalence of monotypic viruses in milk specimens. However, phylogenetic trees demonstrate extensive mixing of viruses between milk and blood specimens. HIV-1 replication in breast milk appears to increase with inflammation, contributing to higher milk viral loads during mastitis.

Background: Irrespective of the tremendous efforts made by Government of India the utilization of MCH services continues to be very low among women belonging to lower socio economic status particularly among slum and migratory population. This significantly upsets country’s declining trend of maternal and infant mortality rate. Therefore a study was undertaken to assess the utilization of maternal and child health services among migratory/slum dwellers in a municipality area.Methods: A community based cross- sectional study was conducted for a period of one month among two hundred eligible women of the study population.Results: Study targeted 1200 households in 16 localities and we obtained information from 200 eligible mothers. Amongst them 74% availed antenatal services from government facilities and only 67% were registered in the first trimester. All mothers received antenatal services. Mother and child protection card was not received by 8.5% of women. 86.1% of them had institutional delivery. 13.9% of mothers delivered at home and 10% of the deliveries were unattended or assisted by friends and relatives. JSY benefits were not availed by 55% of the women.41.5% babies delivered had low birth weight. 14.7% of the children were either partially immunized or not immunized at all. Amongst women belonging to target couple 68% were not using any form of contraception.Conclusions: Utilization of Maternal and Child Health services among the migratory and slum dwellers living in the Municipality area is not satisfactory.