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Introduction: Bloodstream infections (BSIs) in cancer patients are associated with high morbidity and mortality. While common pathogens are well-studied, the role of saprophytic bacteria in BSIs among this population is less understood. To investigate the prevalence and clinical significance of saprophytic pathogens causing BSIs in cancer patients at a tertiary care center. Materials and Methods: This retrospective study included all 200 consecutive adult cancer patients with suspected sepsis over four months. Blood cultures were processed on an automated BACTEC system. Subculture and identification were performed using standard microbiological techniques and the Vitek 2 system. Antimicrobial sensitivity was performed as per CLSI guidelines. Results: The blood culture positivity in these patients was 79% (158/200). Of the 158 positive blood cultures, 10.1% (16/158) were saprophytic pathogens. These included Enterococcus avium, Sphingomonas paucimobilis, Actinomyces meyeri, Kodamaea ohmeri, Elizabethkingia meningoseptica, Aeromonas hydrophila, Achromobacter xylosoxidans, Stenotrophomonas maltophilia, Pantoea dispersa, and Burkholderia pseudomallei. The overall 30-day mortality rate for patients with saprophytic pathogen BSIs was 20%. Conclusion: Saprophytic bacteria have gained recognition as possible human pathogens, especially in immunocompromised patients including cancer patients. Such high-risk patients should be put on empiric antibiotics to improve patient outcomes till the time clinical significance is established.

Background: Diabetes and tobacco use are well-established risk factors for stroke. However, the intersection of prediabetes, tobacco use, and stroke among young individuals remains underexplored. This study aims to investigate the association between pre-diabetes and stroke risk in young tobacco users. Methods: Using the National Inpatient Sample (2019) and relevant ICD-10 codes, we identified young patients with tobacco use disorder and pre-diabetes. Regression analysis considered risk factors (gender, demographics, income, comorbidities) to assess stroke odds. Results: Among 1,017,540 stroke hospitalizations, 1.9 % were pre-diabetic. Pre-diabetics were often older (median age 36 vs. 31), male (59.4 %), Black (33.8 %), and Hispanic (12.2 %), with higher rates of comorbidities, including drug abuse, alcohol abuse, COPD, and CKD (p < 0.001). They also exhibited higher rates of stroke events (1.9 % vs. 0.5 %, p < 0.001). Multivariable analysis after adjusting for confounders, young metabolically healthy smokers with pre-diabetes had a higher risk of stroke (aOR 3.31, 95 % CI [1.67–6.55], p < 0.001). Conclusion: Prediabetes could potentially triple stroke risk in young tobacco smokers. Prospective research is warranted to explore the causal association between pre-diabetes and stroke in the setting of tobacco use.

Introduction: Lung cancer is the most common cause of cancer mortality worldwide, principally because of its late diagnosis. Chronic inflammation plays a significant role in tumour growth and progression via increasing the levels of inflammatory markers in blood. Inflammatory markers are expected to be valuable prognostic biomarkers in cancer. Markers like Absolute Neutrophil Count (ANC), Absolute Lymphocyte Count (ALC), platelet count, Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) may aid in assessing prognosis of lung cancer. Aim: To study the inflammatory markers (ANC, ALC, Platelet count, NLR and PLR) in lung cancer and correlate these markers with cancer stage and histopathological type. Materials and Methods: A hospital-based cross-sectional study was conducted in lung cancer patients at Institute of Respiratory Diseases, SMS Medical College, Jaipur, Rajasthan, India. Sixty patients with lung cancer and sixty controls were included. The clinical characteristics, ANC, ALC, platelet count, NLR and PLR of cases and controls were assessed and compared. Also, the comparison of these inflammatory markers with Tumor, Nodes and Metastases (TNM) staging and histopathological type of lung cancer were documented and results were interpreted. The data analysis was done with the use of Statistical Package for Social Sciences (SPSS) software, IBM manufacturer, Chicago, USA, (Ver.) 26. Results: Mean age (years) of the case and control groups was 60.17 and 61.03, respectively. Distribution of gender in cases and controls was comparable. The major histology of lung cancer was Non-Small Cell Lung Cancer (NSCLC, 81.66%) out of which squamous cell carcinoma constituted 55.00% and adenocarcinoma 21.67%, followed by small cell carcinoma at 18.33%. Overall, 46.67% of the patients belonged to TNM staging IVA followed by IIIB (25.00%). The levels of ANC, platelet count, NLR and PLR were significantly elevated and ALC was decreased in cases as compared to control. There was no statistically significant association between the inflammatory markers ANC, ALC, platelet counts, NLR and PLR with the histopathological type of lung cancer. Mean ANC, platelet count, NLR and PLR were found to be significantly elevated in late stages of lung cancer, whereas, ALC had no such association with the stages of lung cancer. Conclusion: Inflammatory markers (ANC, platelet count, NLR, PLR, ALC) can serve as valuable prognostic biomarkers in lung cancer and can easily be used in resource-limited areas.

Background: The combination of methicillin resistance (MR) and the ability of biofilm formation of Staphylococcus aureus (SA) makes treatment difficult. Biofilm is formed by distinct genetic mechanisms in MRSA and methicillin-sensitive SA (MSSA), and hence, there is difference in the prevalence of biofilms in them. This study investigated the biofilm production in SA and analyzed its correlation with MR. Materials and methods: A total of 261 consecutive Staphylococcus aureus isolated from various clinical samples from January to April 2019 were included in the study. Antibiotic sensitivity was carried out as per Clinical and Laboratory Standards Institute guidelines and cefoxitin disk was used for screening for MR. Total of 147 MSSA and 114 MRSA were taken for further processing. Biofilm formation was determined by tube and microtiter plate methods in all the isolates. The data were analyzed for statistical significance using Microsoft excel software. Results: Resistance to erythromycin, clindamycin, gentamicin, cotrimoxazole, and inducible clindamycin resistance was significantly higher in all the MR Staphylococcus strain including biofilm forming MRSA strains. The biofilm formation was significantly higher in MSSA isolates by both the tube (78.2%) and microtiter plate methods (64.9%). Discussion: Although the antimicrobial resistance was higher in MRSA, the ability to form biofilms was significantly higher in MSSA. Biofilms of MSSA are usually less prevalent than MRSA probably because of the distinct genetic mechanisms involved in the formation of biofilms. The higher biofilm forming ability of MSSA in our study highlights the need for determination of other genes involved in biofilm formation and virulence mechanisms in SA.

Introduction: In development of cancer chronic inflammation plays a major role. Most established determinants of Prostate Carcinoma (PCa) are modern lifestyle, genetics, and age. In the first prostate biopsy, approximately 1 out of 5 men i.e., 20% with PCa may be misdiagnosed. Therefore, there is clear requirement of novel markers, which can detect both clinically significant PCa, and prevent unnecessary biopsy. Some solid tumours found to have association of Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR) and Red cell Distribution Width (RDW). Aim: To study the significance of association of Prostate Specific Antigen (PSA), PLR, NLR and RDW with PCa. Materials and Methods: This study was conducted using the cross-sectional method in the Department of Pathology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan between January 2018 to November 2020. In this cross-sectional study, 84 patients who underwent Trans Rectal Ultrasound (TRUS) guided prostate biopsy were included. Complete Blood Count (CBC) was used to determine PLR, NLR and RDW and biochemical test for PSA. Patients were divided into two groups; having benign and malignant pathology. Unpaired t-test, Mannwhitney U test, logistic regression analysis and correlation were performed for statistical analysis. Results: With the use of univariate logistic regression, association between PSA, NLR, PLR, RDW values and PCa detection was determined. Serum PSA was significantly more in the PCa group (as BPH and prostatitis are both benign conditions so are kept in non-PCa group) compared to other two groups (p

Background: The resistance to colistin and carbapenems in Klebsiella pneumoniae infections have been associated with increased morbidity and mortality worldwide. A retrospective observational study was conducted to determine the prevalence and molecular events contributing to colistin resistance.Methods: Clinical samples were screened for colistin resistance and underlying mechanisms were studied by PCR-based amplification and sequence analysis of genes of two-component regulatory system (phoPQ and pmrAB), regulatory transmembrane protein-coding mgrB, and mobilized colistin resistance genes (mcr-1-8). Gene expression of pmrC and pmrK was analyzed by qRT-PCR, and the genetic relationship was assessed by MLST. The putative effect of amino-acid substitutions was predicted by a combination of bioinformatics tools.Results: Of 335 Klebsiella spp. screened, 11 (3.2%) were identified as colistin-resistant (MIC range, 8 to >128 μg/ml). K. pneumoniae isolates belonged to clonal complex-11 (CC11) with sequence types (STs): 14, 16, 43, 54, 147 and 395, whereby four isolates conferred three novel STs (3986, 3987 and 3988) profiles. Sequence analysis revealed non-synonymous potentially deleterious mutations in phoP (T151A), phoQ (del87–90, del263–264, L30Q, and A351D), pmrA (G53S), pmrB (D150V, T157P, L237R, G250C, A252G, R315P, and Q331H), and mgrB (C28G) genes. The mgrB gene in three strains was disrupted by insertion sequences encoding IS1-like and IS5/IS1182 family-like transposase genes. All 11 isolates showed an elevation in the transcription level of pmrC gene. Mobilized colistin-resistance (mcr) genes were not detected. All but one of the colistin-resistant isolates was also resistant to carbapenems; β-lactamase genes blaNDM-1-like, blaOXA-48-like, and blaCTX-M-like were detected in eight, five, and nine isolates, respectively.Conclusion: All the studied colistin- and carbapenem-resistant K. pneumoniae isolates were genetically distinct, and various mechanisms of colistin resistance were detected, indicating its spontaneous emergence in this bacterial species.

Introduction: The kidney is one of the most highly differentiated organs in the body, affected by various disease processes, some resulting in permanent damage leading to surgical removal of the organ i.e., nephrectomy. Patterns of the indications for nephrectomy vary in different age groups, geographical locations and time periods. Nephrectomy is a common procedure in urological practice done for various conditions like calculi, chronic pylelonephritis, malignancy, obstruction, injury etc., with wide range of morbidity and mortality. Aim: The aim of this study was to study the pattern of histopathological lesions in nephrectomy cases in Southern Rajasthan. Materials and Methods: This study was conducted in the Department of Pathology, Geetanjali Medical College and Hospital (GMCH), Udaipur, Rajasthan. It was a cross-sectional study performed on 121 patients, from January 2015 to March 2020 in which patient’s detail such as age, sex, gross and microscopic findings were retrieved and reviewed. Data was tabulated and analysed. Results: A total of 121 specimens of nephrectomy were included in the study. Among 121 nephrectomy cases, higher incidence was observed in 6th and 3rd decade of life with approximately equal preponderance of male and female; 0.98:1. Out of 121 cases 88 (72.7%) were non-neoplastic and 33 (22.27%) were neoplastic. Conclusion: Benign conditions of kidney are the leading cause of End Stage Renal Disease (ESRD) in the developing world. In our country, there are an increased number of ESRD which require dialysis and transplantation. This study has been performed to know the different causes of nephrectomy in a tertiary care center of India.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) infection is associated with increased morbidity and mortality compared with infections caused by methicillin-sensitive Staphylococcus aureus (MSSA). Treatment of MRSA infection is complicated by the fact that these organisms are resistant to multiple antimicrobial agents, so treatment options are limited. The aim of the present study is determine risk factors association with MRSA as compared with MSSA and to compare the minimum inhibitory concentrations (MICs) of vancomycin, teicoplanin, linezolid and erythromycin to MRSA and MSSA. Methods: A nine-month prospective study was carried out. Staphylococcus aureus strains with clinical correlation, isolated from hospitalised patients, were included in the study. MIC of vancomycin, teicoplanin, linezolid and erythromycin was determined by E-test (HIMEDIA). Risk factors such as immunosuppression, previous hospitalisation, surgical procedure done, invasive devices and antibiotic therapy were determined by a pre-set protocol. Results: A total of 62 S. aureus strains were included in the study. Some 40% of S. aureus strains were methicillin resistant. The risk factors, invasive devices, previous hospitalisation and comorbid illness were found to be significantly associated with MRSA. Borderline significant association was observed with immunosuppression and antibiotic therapy. Erythromycin resistance was observed in 56% of MRSA, while no resistance was observed in MSSA. Teicoplanin MIC50 values and mean MIC were found to be lowest in vitro among vancomycin and linezolid against both MRSA and MSSA. The efficacy of teicoplanin, in terms of clinical and microbiological cure, has not been proven to be superior to vancomycin, but it has a better toxicity profile and has demonstrated a reduced risk of adverse events. Conclusions: Minimising risk factors and attention to alternative antibiotics and infection control practices may ease the problem of management of infections with MRSA.

Introduction: A rise in antimicrobial resistance makes it imperative to study the bacterial aetiology and antimicrobial susceptibility profiles of commonly isolated organisms causing lower respiratory tract infections from both the community and the hospital setting. Aim: To study the bacterial aetiology of Lower Respiratory Tract Infections (LRTI) cases from the community and hospital in the present setting and determine the antimicrobial susceptibility profile of the frequently isolated pathogens. Material and Methods: A prospective observational study was conducted over 15 months at a 1531-bedded tertiary care hospital in Delhi, India. All consecutive sputum, Endotracheal (ET) aspirates and Broncho-Alveolar Lavages (BAL) samples submitted for culture and susceptibility testing were included. Infectious Diseases Society of America (IDSA) definitions were used to categorise the Patients as Community Acquired Pneumonia (CAP) or Hospital-Acquired Pneumonia (HAP) cases. Isolates were identified using conventional methods including colony morphology, gram’s staining, motiliy and biochemical reactions and antimicrobial susceptibility was performed as per CLSI guidelines by disk diffusion. Colistin MIC was determined by agar dilution method. E-test strips were used to determine the MICs of penicillin, cefotaxime and ceftriaxone for isolates of Streptococcus pneumoniae. Results: A total of 4748 samples received, 2555 were sputum, 2141 ET aspirates and 52 BAL samples. A total of 792 non-duplicate organisms were isolated of which 316 isolates were from CAP as compared to 476 isolates from HAP. K. pneumoniae (31%), P. aeruginosa (22%), E. coli (16%) and Acinetobacter species (16%) were the most common bacteria isolated from the community. Amongst the cases of HAP, Acinetobacter species (48%), P. aeruginosa (21%), K. pneumoniae (16%), S. aureus (5%) and E. coli (4%) were commonly isolated. Very high rates of resistance to cephalosporins were observed in both CAP and HAP isolates. K. pneumoniae isolates from hospital were also significantly (p-value

Background: Species specific diagnosis of mycobacterial infection is crucial because treatment of infections caused by Mycobacterium tuberculosis (MTB) differs from that of non-tuberculous mycobacterial (NTM) species. The species identification used to be cumbersome and non-reproducible a decade ago. Objectives: Recently, some commercial tests have been made available to differentiate the MTB and NTM growths in culture media. Sensitivity and specificity of these tests was evaluated. Materials and methods: In this double blind study 572 clinical samples were cultured in an automated BACTEC-MGIT-960 system. A total of 147 (25.7%) samples were MGIT culture positive. These cultures were subjected to an in-house m-PCR (which amplifies hsp-65, esat-6 and ITS region for MAC), two commercial immune-chromatographic tests (ICTs) and phenotypic tests. Results: Of the 147 MGIT positive cultures, m-PCR was able to correctly identify MTB in 123 cultures and NTM in 24 which included 3 MAC isolates. m-PCR showed 100% agreement with two gold standard methods-the nitrate reductase assay and PNB tests-in correctly identifying MTB. Commercial strips were able to correctly identify MTB in 120 (97.5%) of 123 cultures, while 3 (2.5%) isolates were falsely identified as NTM. However, none of the growth negative spent medium gave false positive results in any of the tests. None of the commercial strips misidentified any of the 24 NTM as MTB; hence, specificity of these strips was 100%. Of the 2 IC test systems, both SD Bioline and BD TBc strip tests missed 2.5% of MTB isolates and misidentified these as NTM. Conclusion: The in-house m-PCR was found to be the most accurate and efficient tool for identifying the MTB, MAC and other NTMs.

Introduction: With advancing health care sciences, the prevalence of Accidental Exposure to Patient’s Blood (AEBP) amongst Health Care Personnel (HCP) is bound to increase. The only means of preventing such accidental exposure is safe working practices. It is the responsibility of the teachers to inculcate these practices amongst their students. Aim: To evaluate the knowledge, practice and attitude regarding Post Exposure Prophylaxis (PEP) and Hepatitis-B Virus (HBV) immunization amongst faculty and undergraduate students and to assess the frequency of these occupational exposure with the objective of inculcating safe working practices in the teaching curriculum. Materials and Methods: The present study is a descriptive analytical cross-sectional study done from May 2012 to August 2012 in a newly established ESIC dental college at Rohini, Delhi. A 36-item survey questionnaire was distributed to 50 faculty and 115 dental undergraduate students. The survey included questions on demographic details of the respondents, the prevalence of AEBP, the knowledge regarding PEP and HBV immunization and the status of the respondents. The data was analysed using SPSS 12.0 software using various statistical tests such as frequency analysis, Chi-square test and others. Results: The mean age of the study group was 23.3±6.3 years. The prevalence of such accidental exposure was high being 49.7% in our study group. More than half of these respondents did not report the injury. The knowledge regarding the transmissibility of blood borne pathogens and the post exposure prophylaxis was suboptimal amongst the students and even teachers. Almost 20% of the study group was not immunized for HBV. Conclusion: Managing AEBP in HCP is a challenging issue. They are highly prevalent, largely underreported and poorly managed because of the unawareness regarding the hospital’s protocols for reporting and PEP as is seen in the present study. Besides the administrative measures, orientation and reinforcement training of all the staff including faculty is desirable to maintain high level of knowledge and effectively handle such occupational exposure.

Objectives: Urinary tract infection (UTI) as a result of Candida spp. is becoming increasingly common in hospitalized setting. Clinicians face dilemma in differentiating colonization from true infection and whether to treat candiduria or not. The objective of the present study was to look into the significance of candiduria in catheterized patients admitted in the ICUs and perform microbiological characterization of yeasts to guide treatment protocols. Materials and Methods: One hundred consecutive isolates of Candida spp. from the urine sample of 70 catheterized patients admitted in the ICU were collected and stocked for further characterization. A proforma was maintained containing demographic and clinical details. Blood cultures were obtained from all these 70 patients and processed. Species identification of yeasts was done on VITEK. Results: Candiduria was more common at extremes of age. The mean duration of catheter days was 11.1 ± 6 days. Other associated risk factors such as diabetes mellitus and antibiotic usage were seen in 38% and 100% of our study group. Concomitant candidemia was seen in 4.3% of cases. Non-albicans Candida spp. (71.4%) emerged as the predominant pathogen causing nosocomial UTI. Conclusion: The present study reiterates the presence of candiduria in catheterized patients, especially in the presence of diabetes and antibiotic usage. Non-albicans Candida spp. are replacing Candida albicans as the predominant pathogen for nosocomial UTI. Hence, we believe that surveillance for nosocomial candiduria should be carried out in hospitalized patients.

Background: The presence of anti-HBc IgG in the absence of HBsAg is usually indicative of a past self-limiting HBV infection. But it is frequently associated with co-infection with HCV which can worsen the existing status of chronic liver disease (CLD). Objectives: The present study was planned to evaluate the significance of isolated HBc IgG positivity in patients of CLD and look for the presence of HCV co-infection in such patients. Methods: Clinical profiles and biochemical tests were done for all the 77 CLD cases included in the study. Blood samples were taken from these patients and tested by the commercially available EIA for the presence of HBsAg, anti-HBc IgG, anti-HBs and anti-HCV. HBV DNA was detected by amplifying the surface region in all the cases. Results: Isolated anti-HBc IgG positivity defined as the presence of anti-HBc IgG in absence of any other serological markers of HBV infection was detected in 28 patients . Out of 64 patients positive for anti-HBc IgG 36 had the markers of HBV, either HBsAg, HBV DNA or anti-HBs alone or in combination. There was a significant association between isolated anti-HBc IgG positivity and HCV co-infection. Conclusion: Anti-HBc IgG should be tested in all patients with CLD as it is frequently the only marker of HBV infection in such patients and they should be monitored closely as such patients can develop CLD. Presence of co-infection with HCV should be actively searched for in such patients.

Background. Tuberculosis (TB) is a disease that affects hundreds of millions of people across the world. However, the incidence in developed countries has decreased over the past decades causing physicians to become unfamiliar with its unspecific symptoms. Pregnant individuals are especially difficult because many symptoms of active TB can mimic normal physiological changes of pregnancy. We present a case report of a 26-year-old multiparous woman, G4P3003, at 38-week gestation with a history of positive PPD who emigrated from Ghana 6 years ago. She came to the hospital with an initial complaint of suprapubic pain, pressure, and possible leakage of amniotic fluid for the past week. Patient also complained of a productive cough for the past 3 to 4 months with a decrease in vision occurring with the start of pregnancy. Visual acuity was worse than 20/200 in both eyes. Definitive diagnosis of active TB was delayed due to patient refusal of chest X-ray. Fortunately, delay in diagnosis was minimized since patient delivered within 24 hours of admission. Active TB was confirmed with intraocular dissemination. Patient had optic atrophy OS (left eye) and papillitis, choroiditis, and uveitis OD (right eye) due to TB infiltration. Fetus was asymptomatic and anti-TB therapy was started for both patients.

Background & objectives: Several outbreaks of neonatal septicemia by extended spectrum beta lactamases (ESBL) producing isolates are not uncommon & are associated with increased mortality. Moreover, detection of ESBL in isolates that produce Amp C beta lactamases is problematic. So, clinical laboratories need to develop quick screening methods for detection of ESBL producing strains. Materials & methods: Out of 600 samples of blood culture from neonatal intensive care unit (NICU) patients, 54 Klebsiella pneumoniae were tested for ESBL by screening & confirmatory tests recommended by clinical laboratory standard institute (CLSI). In addition, double disk synergy test (DDST), modified double disk synergy test (MDDST), direct modified three dimensional tests (DMTDT) & indirect modified three dimensional tests (IMTDT) were evaluated for optimum detection of ESBL in Amp C producing isolates. Results: From 54 Klebsiella pneumoniae, 48 were screen positive for ESBL by CLSI criteria. ESBL detection was confirmed in 44 isolates. Phenotypic confirmatory disk diffusion method (PCDDT) by CLSI detected ESBL in 41/48 isolates. DDST using amoxicillin-clavulanic acid detected the same in 36/48 cases. MDDST using cefepime & piperacillin-tazobactam detected ESBL in 44/48 cases, including 3 isolates having Amp C enzyme which was confirmed by modified three dimensional tests for Amp C enzyme. DMTDT detected only 4 isolates with ESBL production. IMTDT detected all 44 ESBL producing isolates. Conclusion: The prevalence of ESBL producing Klebsiella pneumoniae in our NICU was 81.48%. MDDST & DMTDT seem to be superior to PCDDT, DDST & IMTDT for detection of ESBL in Amp C producing isolates

Introduction: A Prospective study “Spectrum of Microbial flora in diabetic foot ulcer and its antibiotic sensitivity pattern” was carried out in a tertiary care hospital, Ahmedabad on 125 patients in which 85 were male patients and 40 were female patients. Material and Methods: Swabs samples were collected from the edge and margins of ulcers and organism were identified by gram staining culture and biochemical reactions. Results: Out of 125 specimens 108 specimens showed growth of organisms. Total 157 aerobic organisms were isolated from culture positive specimens. It represents an average of 1.25 organisms per case. Among these organisms, 130 gram negative and 27 gram positive organisms were isolated. Pseudomonas aeruginosa (30.57%) was predominant organism followed by Klebsiella spp. (22.29%). Staphylococcus aureus were 12.74% in which Methicillin resistant S. aureus (MRSA) was 55%. Conclusion: incidence of growth was 86.4% in which Pseudomonas aeruginosa (30.57%) is most common isolate. Organisms in mixed infections showed multidrug resistance as compared to single isolated strain. Diabetic foot infections are polymicrobial in nature. As the Wagner’s grade increased, the prevalence of isolates also increased.