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Native valve endocarditis owing to Mycobacterium abscessus (M. abscessus) is extremely rare and only a few cases have been reported in the literature. We present a case of a 44-year old male patient, a coronary artery disease (CAD) case with a stent in situ with pyrexia of unknown origin (PUO). He started becoming febrile following placement of stent and continued to remain febrile for duration of five months before coming to our centre. Echocardiogram showed vegetations on the aortic valve and paired blood cultures grew M. abscessus. Antibiotics including Clarithromycin were added to his treatment and a valve replacement was planned. The patient underwent valve replacement, however succumbed to the illness despite best efforts. It is difficult to diagnose M. abscessus in Gram stain as they appear as diphtheroids and may be interpreted as contaminants. Even an accurate diagnosis makes this organism difficult to treat. Early surgical intervention along with aggressive antibiotic therapy is recommended for treatment. [ABSTRACT FROM AUTHOR]

Introduction: Although diarrheal diseases are highly preventable, they remain one of the leading causes of mortality and morbidity in the pediatric population in developing countries. Knowledge of etiological agents is essential to implement public health programs. Viral infections are the most common cause of acute infectious diarrhea among children. There is a paucity of information regarding viral enteropathogens responsible for diarrhea in India, as many hospitals do not routinely carry out diagnostic tests for viral detection. Aim and Objectives: To estimate the prevalence of viral enteropathogens in children under five years of age presenting with acute diarrhea using real-time multiplex polymerase chain reaction (PCR) and its correlation with clinico-demographic features. Methodology: A cross-sectional study was carried out in a tertiary care center in Maharashtra from January 2016 to June 2019. Our study included 300 children who were under five years old with acute diarrhea. Standard protocols were advocated for the collection and transportation of stool samples. All samples were subjected to real-time multiplex PCR (Light cycler 480 Roche) using Fast Track Diagnostic kits for viral gastroenteritis. Data analysis was done using descriptive and analytical methods. Results: In our study, 57% of samples were positive for viral enteropathogens. Rotavirus (32%) was the most common isolate, followed by Norovirus Genogroup II (GII) (17%). The majority of pathogens were isolated from children less than 2 years of age. Conclusion: There is a need to test stool specimens of clinically confirmed diarrheal patients for enteric virus. This will avoid blind antibiotic treatment. [ABSTRACT FROM AUTHOR]

A structured Attitude Ethics and Communication (AETCOM) module for undergraduates exists. For ensuring that the module achieves what it is intended to achieve, there was a felt need to develop a learning portfolio with an emphasis on reflections and with a scope for assessment. The AETCOM module by NMC has laid out objectives, lesson plans, and case-based scenarios. Hybrid portfolio development was necessary to align the sessions to the objectives and lesson plans and to help students capture their learning process with self-reflection, and at the same time, ensure the scope of assessment of these activities. Hence, writing reflections was considered the most important step. Measures were taken to train students in writing reflections, and faculty development workshops were also conducted. An evaluation was done using Kirkpatrick model level I–III using student's feedback form, scores of rubric matrix for assessment of reflections and one–on-one interaction with students by trained faculty. Faculty perspectives on portfolio development were collected. A significant improvement in students' self-assessment scores on AETCOM module was seen (p <0.05). An assessment of reflections using a rubric matrix showed that all the students reached at least grade B by the end of three months. More than 90% of faculty members felt that the faculty is vital for assessing AETCOM. The development of a hybrid portfolio for AETCOM requires faculty development and special sessions for students on writing reflections. The hybrid portfolio provides the learner to self reflect, and a rubric matrix can be used to assess reflections. [ABSTRACT FROM AUTHOR]

Introduction: Theory papers have been the most commonly employed method to assess learning outcomes in medical education. In these papers, both recall abilities and higher‑order cognitive functions need to be assessed giving proper weightage as per relevance. Hence it becomes necessary that valid assessment methods are employed to evaluate the required objectives/competencies. The objective of the study was to develop a method for analyzing postgraduate question papers of various specialties. Methodology: A rubric matrix was created with three broad objective criteria to assess framing and layout of the questions in each paper, analysis of different sets for same examination, and finally an overall assessment of all the papers for each subject. Results: A total of 28 specialty papers were available. A total number of papers analysed = 340. The overall mean score out of total 60 marks was 38.64 ± 4.5. It was seen that the majority (60%) of the departments have been graded as fair on analysis of the theory papers. None of the departments were graded as very good, while 7% of them were graded as good. Although a very minuscule percentage of the papers had grammatical errors and duplication of questions in the sets, only 57% of the departments had done a proper moderation and 21% had used higher domains of learning for assessment. Conclusion: Analysis of postgraduate question papers showed that the questions asked for postgraduates are more recall‑based instead of higher taxonomy of cognitive domain. [ABSTRACT FROM AUTHOR]

A pulmonary nodule is a common radiological finding encountered in routine medical practice. It needs to be extensively evaluated as the differential diagnosis can range from sinister malignancies to fully treatable infectious causes. Here, we present a rare case of pulmonary paragonimiasis presenting as pulmonary nodule. This case report aims to sensitise the medical practitioner regarding pulmonary paragonimiasis which is completely treatable but carries a high risk of being under diagnosed. [ABSTRACT FROM AUTHOR]

Hepatitis B (HepB) is an important vaccine preventable infection among healthcare workers (HCWs). Vaccination against Hep B virus, remains the foremost preventive approach. This study aims to measure the antibody titres to Hep B surface antigen (anti-HBs) in a mixed cohort of HCWs. It also aims to study the association between time since vaccination and the anti-HBs titres thus evaluating the duration of seroprotection A total of 200 HCWs, including nursing students (n = 112), nursing staff (n = 49), laboratory technicians (n = 30) and doctors (n = 9) who had received all three doses of the Hep B vaccine and met the inclusion criteria of having taken all three doses of vaccine were included in this study. Anti-HBs titres were estimated by bioMérieux mini VIDAS® automated immunoassay based on the principle of enzyme-linked fluorescence assay. Two hundred subjects aged 19 to 52 years were included in the study; mean age was 27.29 ± 0.568 years. Duration since vaccination in the study cohort was ≤ 5 years in 149 (74.5.0%), 6–10 years in 20 (10.0%) and >10 years in 31 (15.5%) subjects. Postvaccination antibody titres were > 100 mIU/ml in 85.0%, 10-100 mIU/ml in 11.0% and ≤ 10 mIU/ml in 3.5%. There was a decline noted in antibody titres as duration after vaccination increased. Increasing age was associated with falling protective titres. The study revealed that majority of the HCWs had adequate anti-HBs titres and were protected after vaccination. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance (AMR) is a real threat having the potential of impacting public health immensely. Biocides may contribute to AMR as they are routinely used in household formulations, often in suboptimal concentrations. Gram-negative bacteria like Pseudomonas aeruginosa (P. aeruginosa) can adapt to biocides such as chlorhexidine and cetrimide (CHX + CET) on repeated exposure and develop cross-resistance to antibiotics. Aim and Objective: The aim was to test CHX + CET laboratory-adapted clinical isolates of P. aeruginosa for the development of cross-resistance to antipseudomonal antibiotics. Materials and Methods: Ten clinical isolates of P. aeruginosa were included in the study. The initial antibiotic susceptibility pattern was noted before they were exposed to increasing concentrations of CHX + CET over several days. Briefly, 10 µl of bacterial suspension was inoculated into 10 ml of nutrient broth with the biocide and incubated at 37°C for 48 h. New series of tubes with increasing concentration of biocide were inoculated with growth from the previous tube every 48 h. Till, no further growth was obtained. Antibiotic susceptibility testing for antipseudomonal antibiotics by the disc diffusion as well as the minimum inhibitory concentration (MIC) by VITEK 2 bacterial identification system was performed and repeated before and after exposure to the biocide. The difference in the zone diameter and MIC was noted. Results: Significant difference (P < 0.05) in the mean of the zone size before and after exposure to CHX + CET was noted. Furthermore, there was an increase in MIC postexposure to the biocide. Conclusions: P. aeruginosa on exposure to biocides developed antibiotic resistance. [ABSTRACT FROM AUTHOR]