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Background: Infections caused by metallo-beta-lactamases (MBLs) producing Gram-negative bacteria (mainly Enterobacterales) pose a great challenge for clinicians in treating these multidrug-resistant infections. In recent times, combination antibiotic therapy with ceftazidime–avibactam (CAZ-AVI) with aztreonam (ATM) has been researched by a number of laboratories worldwide and has gained much clinical attention. This study evaluated a practical laboratory method of testing for clinically significant in vitro synergy between CAZ/AVI + ATM in New Delhi MBLs (NDM) producing Gram-negative organisms. Materials and Methods: A total of 100 isolates of carbapenem-resistant Enterobacteriaceae (Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Enterobacter cloacae) were tested for synergy between CAZ/AVI + ATM using E-strip of CAZ/AVI and disc of ATM. The minimum inhibitory concentration value of CAZ/AVI was measured and the zone of inhibition was observed when ATM was placed parallel to the E-strip on a lawn culture of an isolate. Simultaneously, all isolates were tested for NDM and OXA-48 by Xpert Carba-R. Results: Of 100 isolates, 63/100 (63%) were harboring OXA-48 beta-lactamase, 54/100 (54%) were harboring NDM beta-lactamase and 18/100 (18%) were harboring both (OXA-48 and NDM). In vitro synergy between CAZ/AVI + ATM was noted in 99 isolates (99%). Conclusion: A significant synergy was demonstrated in vitro with CAZ/AVI + ATM combination therapy and seems to be a promising treatment strategy for infections caused by Enterobacterales harboring NDM and OXA-48 beta-lactamases.

Background: Frontline workers were the first cohorts vaccinated with Covishield™ (ChAdOx1 nCoV-19) vaccine with dose-interval of 4–6 weeks. We evaluated vaccine effectiveness (VE) of Covishield and studied epidemiological risk factors associated with COVID-19 during second wave of COVID-19 pandemic. Methods: We conducted a 1:3 case-control community-based study, as per WHO protocol. We identified case-patients from COVID-19 surveillance system and recruited controls from the same community as per the WHO protocol. Information was obtained through questionnaire; and all potential confounders were identified to evaluate VE. Results: We enrolled 243 case-patients and 712 controls. Adjusted VE of fully vaccinated was 74% (95% confidence interval [CI]: 53%–86%) against infection and 91% (95% CI: 78%–97%) against moderately severe disease. Pre-infection high-risk exposure events such as ccontact with COVID-19-positive patient, visit to a crowded place, and attending social-gathering in confined space were significantly associated with contracting infection, with odds ratios 10.1 (95% CI: 5.6–18.3), 6.0 (95% CI: 1.8–20.2) and 3.9 (95% CI: 1.4–10.5) respectively. The use of double-mask and past COVID-19 infection was 60% and 70% protective, respectively. Conclusion: Covishield vaccine is highly effective against infection and mainly against disease-severity during high-transmission settings. We recommend three-layer shield to minimize breakthrough and re-infections comprising of vaccination, double-masking, and avoiding “pre-infection high-risk exposure events.”

Introduction: Primary gastric lymphoma (PGL) accounts for

Introduction: From being declared as Public Health Emergency of International Concern and the transmission dynamics of COVID-19, outbreak control has been the cornerstone of combating COVID-19 cases within communities and clusters. An outbreak investigation of COVID-19 positive cases was conducted in a close community setting at an industrial warehouse which included working and residential areas in the premises, with the aim to break the chain of transmission rapidly and to formulate preventive strategy for dealing with other outbreaks in a community setting. Materials and Methods: This was a study where a rapid outbreak response was carried out after two individuals tested COVID-19 positive. Following the national and local guidelines, immediate decongestion followed by aggressive contact tracing, testing and isolating the cases were done. Results: After the rapid contact tracing exercise, contacts were identified, quarantined and tested. Daily monitoring of the contacts revealed six symptomatic confirmed cases and on testing, 19 asymptomatic contacts were positive. All confirmed cases were immediately admitted to the hospital. Additional two positive cases reported from family contacts. The mean age of the individuals was 46 years. There were 9 individuals with co-morbidities and two individuals developed acute respiratory distress syndrome and expired in the hospital. The secondary attack rate was calculated to be 17.51%. Conclusion: Prompt public health measures by rapid response team, creation of containment zone, contact tracing, early isolation along with daily influenza like illness screening and strict quarantine effectively helped in containment of the outbreak in the population under study.

Background: The utility of antibody tests in policy making is limited to seroprevalence surveys. World Health Organisation has stated that recovered people have antibodies to SARS-CoV-2. Convalescent serum contains antibodies that can neutralize the virus in cell cultures and IgG is both a marker for viral exposure and an indicator of recovery. We undertook this study to report immune response as a return to work strategy in a containment zone of 757 adults from a working mens' hostel. Methodology: The individuals were divided into three cohorts. Cohort-A comprised of RTPCR confirmed cases, Cohort-B comprised of those who were admitted as suspects but were negative in Rt-PCR test and Cohort-C were those, who remained asymptomatic. We studied the clinical features and undertook a qualitative antibody test of all adult males from the hostel after transmission of the disease was assumed to be over in the containment zone. Result: Dry cough, sore throat and fever were the most common presenting symptoms. (Fig 1). On serology testing, 47/87 (54.04%) tested IgG positive from Cohort A and 25/74 (32.05%) individuals were IgG positive from Cohort B with a significant statistical difference (p

Background: Influenza is a global disease with frequent outbreaks which vary in extent and severity. Although Influenza Like Illness (ILI) has a low fatality, it can cause a spurt in hospitalizations and sick absenteeism. Understanding the risk factors and using the knowledge to limit complication is the need of the hour to ensure adequate resource allocation and patient outcome. Aim and Objective: The study analysed the proportion of influenza cases requiring additional supportive care and the factors associated with it in the study population. Material and Methods: A retrospective observational study was conducted on 139 patients who were admitted with ILI at a tertiary care centre in Mumbai. Patients records were evaluated in detail for clinical history, socio-demographic details, relevant co-morbidities, physical examination findings and imaging & laboratory investigations. IBM SPSS version 22 was used for statistical analysis. Results: The proportion of Influenza patients requiring additional support (IPRAS) was 18.71%(95% CI 13.1% to 26%) in the study population. The most common additional support was extra oxygen therapy in 53.85% of IPRAS patients. Conclusion: The risk factors with significant association with IPRAS were higher age of the individual, H1N1 influenza, female gender, and presence of 3 or more co-morbidities, presence of fever, cough or breathlessness at presentation, higher respiratory rate and lower SpO2 at the time of presentation.

Background: Urinary bladder tumors are the second most common tumors affecting males. The aim of the study was to evaluate the various histopathological findings in various bladder tumors and their correlation with exfoliative urine cytology. Design: This is an observational study carried out over a period of 7 years at a tertiary care hospital between January 2010 and January 2017. Materials and Methods: Tumors were divided into invasive and noninvasive urothelial carcinoma and were further classified into high-grade or low-grade urothelial cancer. Urine cytology smears from all these patients were also were studied. Cytological findings were correlated with histopathological findings. Result showed that bladder tumors were commonly seen in males with average age of presentation being the sixth decade. The most common type of carcinoma seen was low-grade urothelial carcinoma-noninvasive type. Urine cytology was positive in 47.46% patients. Sample Size: In our study, 113 cystoscopic biopsies were included over a period of 7 years (85 males and 28 females). Conclusion: Accuracy of diagnosing malignancy in urine cytology varies, and it depends on the presence of diagnostic yield in the urine cytology, processing of the sample, and experience of the cytopathologist. Urine cytology should be reported in a background of detailed clinical information and should always be followed by histopathological examination.

Context: Phototherapy is the mainstay of treatment for about 3% of neonates in India who develop significant jaundice in phototherapy range. New devices have been introduced in the market over the past few years. Aims: To compare the efficacy of three types of phototherapy machines, namely Blue and White, Compact Fluorescent Lamp, and Light Emitting Diode type. Settings and Design: A non-randomized prospective interventional study conducted in a tertiary care hospital of Western India. Material and Methods: Ninety neonates with phototherapy range hyperbilirubinemia were assigned into three groups of 30 neonates each to receive phototherapy using one of the three types of phototherapy machines. Need for exchange transfusion, total serum bilirubin (TSB) at 24 hours post-phototherapy and side effect profile were recorded. Decision to stop phototherapy was based on acceptable reduction of serum bilirubin to below phototherapy range. Statistical analysis used: Medcalc® Version 11.4.2.0 Software was utilised. Comparison of mean TSB was done using one way ANOVA. P-value of

Catheter-associated complications are common, expensive, and often preventable by reducing unnecessary catheter usage. These complications range from most common nosocomial infection to uncommon conditions such as urethral diverticula and ischemic necrosis of the penis. Often, removal of a single known essential cause may be sufficient to prevent a disease. This review raises issues associated with urinary catheterization and emphasizes on the need of preventive measures a physician should take to reduce disappointing situations. The main objective of this literature review is to intercept or oppose unwanted catheter use and thereby, the disease processes associated with urinary catheterization. There is well-described literature available on catheter-associated urinary tract infection, but little is known about noninfectious complications resulting from catheter use; therefore, we also tried to draw attention on these unusual complications.

Low backache as an initial manifestation of acute lymphoblastic leukemia (ALL) in adults has been rarely reported. In this hematological disorder, although bone marrow is replaced by malignant cells, not many cases of low backache as an initial presentation of ALL are reported. We present a series of clinical cases with low backache, which on evaluation found to have ALL.

Objective: To evaluate the antibiotic resistance patterns of Pseudomonas aeruginosa isolated from various clinical samples in a tertiary care hospital. Materials and Methods: Between Mar 2013 to Feb 2014, 386 strains of P. aeruginosa were isolated from different clinical specimens and fully characterized by standard bacteriological procedures. Antimicrobial susceptibility patterns of each isolate were carried out by Kirby- Bauer disk diffusion method and results were interpreted according to Clinical Laboratory Standard Institute guidelines. Results: The isolation rate of P. aeruginosa in this study was 11.5%. Pus,urine and tracheal aspirates were important sources of P. aeruginosa. The highest resistance was reported to Ciprofloxacin while the lowest resistance to Imipenem. 17% of P. aeruginosa isolates were foundto bem ulti - drug resistant (MDR). Conclusion: The clinical significance of thesefindings emphasizes the importance ofjudicious and rational treatment prescription to limit the spread of antimicrobial resistance among P. aeruginosa strains. There is a need for periodical antimicrobial surveillance to monitor the resistance patterns in hospitals and prevent further spread of MDR strains.

Acinetobacter baumannii is a Gram Negative coccobacilli implicated in causation of wide spectrum of nosocomial infections. Multidrug resistant Acinetobacter (MDR Acinetobacter) is emerging as an important cause of hospital acquired infections like urinary tract infection, ventilator associated pneumonia, meningitis, bacteremia and infection in burns patients. The purpose of this study is to determine the prevalence of Acinetobacter infections and ascertain the burden of MDR Acinetobacter in this hospital. This study is a retrospective review of Microbiology laboratory culture reports during the period 01 Jan 2012 to 31 Dec 2012 at INHS Asvini and includes 172 isolates of Acinetobacter baumannii. Multidrug resistant Acinetobacter was defined as resistance to more than three classes of antibiotics. Out of a total of3283 different isolates from various clinical samples during this period, 172 isolates of Acinetobacter baumannii were obtained. Antimicrobial susceptibility patterns for all available antibiotic classes for Acinetobacter were studied. Of all the Acinetobacter baumannii isolated, 38% were found to be Multidrug resistant which were resistant to most of the commonly used antibiotics including Aminoglycosides, Cephalosporins, Carbepenems, Extended Spectrum Penicillins and Fluroquinolones. The data suggests that Acinetobacter infections are a growing threat affecting a considerable proportion of critically ill patients.

Long-time urethral catheterization may be responsible for various complications such as urethral stricture, urethral fracture, urinary tract infections, and hypospadias. Hypospadias is the most common congenital anomaly of male external genitalia. However, urethral catheter-induced iatrogenic hypospadias is a rare entity. In this article, we describe a case of an elderly male who was found to have iatrogenic hypospadias 2 months after urinary catheterization.

Lofgren’s syndrome is characterized by triad of Erythema Nodosum, hilar lymphadenopathy and polyarthralgia. [1] It is mostly seen as an acute form of sarcoidosis, in 35 % of such cases. In India sarcoidosis is rare condition and only 5-6% of such rare cases may present as Lofgren ′s syndrome. Other possible causes ofLofgren ′s may be infections and environmental factors as the disease tends to have increased incidence during spring season. [3] In this article we are reporting a rare case of Lofgren′s with rarer presentation of Erythema Nodosum, polyarthritis, hilar lymphadenopathy and episcleritis, from India which was triggered by infection.

A 20 year old male presented with fever associated with eruption of papules, plaques and vesiculobullous lesions on the chest, back, extremities, palms, soles, and genital mucosa of 20 days duration. Histopathological examination revealed epidermal clefts, edema and vacuolar degeneration of keratinocytes, basal cell degeneration, and dermal perivascular lymphocytic infiltrate. On the basis of clinical features and histology, a diagnosis of febrile ulceronecrotic Mucha-Habermann disease (FUMHD) was made. Treatment with doxycycline (100 mg BD for 4 weeks) and oral prednisolone 60 mg/day tapered to 25 mg in 4 weeks led to initial response that was followed by a relapse on tapering steroid. Addition of methotrexate (7.5 mg increased to 15 mg in 2 weeks) led to a dramatic response.