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Background Dental students were adversely impacted by coronavirus disease-2019 (COVID-19) leading to changes in their personal and professional lives. They have been under stress and adapting to new technologies and scenarios at the workplace. With the omicron threat looming, new challenges await them. The study aims to assess perceptions, stress, and coping mechanisms adopted by dental students during COVID-19 times, and to invite suggestions to improve the professional scenario. Methodology A cross-sectional self-administered questionnaire-based study was planned for third- and final-year undergraduate and postgraduate dental students from dental colleges around the Chandigarh region. Convenient sampling was done. Thirty-item questionnaire was sent via email and WhatsApp groups in the form of Google Form. p-Value less than 0.05 was taken as statistically significant. Results Overall, 389 students participated, with majority (93.8%) being 21 to 25 years of age, females (75.6%), and undergraduates (90.2%). Also, 35% had a positive COVID-19 family history. Social media was the most common source (81.1%) of information regarding the pandemic. The majority received online teaching (84.83%) and gave online exams (58.6%). Altered sleep patterns (81.5%) and increased screen time (82%) were reported. Being female (stress score 11.15; p Conclusion Decreasing number of stressors and increasing involvement in the coping mechanism will help students to better embrace the impact of the COVID-19 pandemic.

Objectives: The present study was undertaken to understand the microbiological profile, clinical presentation, associated bacteraemia and present antibiogram pattern of various isolates from patients with biliary tract infection admitted in a tertiary care centre in India. Methods: In this retrospective study, Bile samples were collected from adult patients admitted in our hospital and were processed as per standard protocol. The results were interpreted as per Clinical Laboratory Standards Institute (CLSI) 2020 guidelines. Bacterial isolates were categorised as MDR and PDR as per CDC. Results: 326 bile samples were sent for aerobic culture and susceptibly testing. 197 (60.42%) of these samples were culture-positive, and the remaining 129 (39.57%) were sterile in nature. A total of 289 pathogens were isolated; Escherichia coli (37.37 % n=108) was predominant, followed by Klebsiella pneumoniae (25.60%, n=74). 170 (60.49%) isolates were resis­tant and the remaining 111 (39.50%) were susceptible to various drugs tested. 27 ESBL producing strains of E.coli( n= 20) and Klebsiella spp (n= 7) and 21 CRE producing strains of E coli ( n= 12) and Klebsiella spp( n=9) were reported . 5 isolates of Klebsie­lla spp. and a single E.coli were PDR and susceptible to colis­tin (MIC =0.5 mcg/ml) by microbroth dilution test. Conclusion: The soaring rates of infection mainly by gram-negative bacteria are a red flag with the emergence of multidrug resistant organisms and change in the anti-microbiological spectrum and pattern of biliary tract infections, there is an urgent need for the empirical and prophylactic an­timicrobial therapy in every clinical setting.

The 2019 novel coronavirus disease (COVID-19) pandemic in India has affected over 8.14 million people and is a major concern for the people and governments across due to its impact on individuals as well as on public health. The present study striven to determine knowledge, attitude, and practices of healthcare workers (HCWs) toward COVID-19 in a super specialty center. Materials and Methods: A questionnaire-based survey was carried out among 100 HCWs belonging to the different cadre and specialties of a Super specialty hospital in North India. Questionnaire focused on the awareness, attitude, and possible practices toward ensuring safety for themselves as well as breaking the chain of transmission. A convenient sampling method was used for data collection and descriptive statistical analysis was carried out to assess the data. Results: Of the 100 participants, 52 were male and 48 were female mostly belonging in the age group of 25–40 years. Most participants (80%) used social media to obtain information on COVID-19. More than 80% of the respondents knew and practiced different precautionary measures. However, about 31% cases were associated with poor attitude and practices of COVID-19. Conclusion: Most HCWs surveyed were well informed about novel severe acute respiratory syndrome coronavirus 2 and took adequate measures in preventing the spread of infection. However, continued professional education is advised among HCWs to curtail the spread of this disease.

Background: Cryptococcal meningitis has emerged as an important opportunistic central nervous system (CNS) infection in Human Immunodeficiency Virus (HIV) positive patients. It is associated with a high mortality rate. Hence early diagnosis is necessary to start appropriate treatment. Cryptococcosis is generally found in association with acquired immunodeficiency syndrome (AIDS) although it has been reported to cause disease in HIV-seronegative patients also. Objective:Prevalence of Cryptococcal meningitis in a tertiary care centre. Material & Methods: A total of 93 Cerebrospinal fluid samples from suspected cases of fungal meningitis were received in the microbiology department of GB Pant Hospital(GIPMER) from January to June 2018. Samples were subjected to direct microscopy- wet mount, India ink preparation and Gram stain, Cryptococcal antigen detection(Latex agglutination), and Fungal culture. In vitro susceptibility of Cryptococcus isolates to Fluconazole, Voriconazole, 5- Flucytosine and Amphotericin B was performed using standard broth microdilution method. Results: Out of 93 CSF samples, 6 were positive for India ink preparation and showed gram positive budding yeast cells by gram staining. All 6 samples were positive for the cryptococcal antigen test and fungal culture. Five were identified as C. neoformans and one C. gatti. All strains were susceptible to Amphotericin B. Four patients were HIV reactive and succumbed to the diseaseduring treatment. Two patients were found to be coinfected with Hepatitis B virus. Ashish Bajaj1, Bibhabati Mishra2, Poonam S Loomba2, Archana Thakur3, Abha Sharma4, Prachala G Rathod1, Madhusmita Das1, Ashna Bhasin1 1Senior Resident, 2Director Professor, 3Director Professor & Head, 4Assistant Professor, Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India ABSTRACT Cryptococcal meningitis has emerged as an important opportunistic central nervous system (CNS) infection in immunosuppressed patients.It is associated with a high mortality rate(>30%) in immunosuppressed patients especially those infected with HIV, hence early diagnosis is necessary to start appropriate treatment. Prevalence of cryptococcal infection is increasing in developing nations including India as per some recent studies.(1) Conclusion: Index of suspicion of Cryptococcus infection as a possible cause of meningitis must be considered in chronic meningitis cases. Microscopy (India ink preparation) may be used as a cheap and rapid diagnostic tool.

A wide plethora of chemical endodontic irrigants are used to achieve the desired results in terms of disinfection and removal of debris besides mechanical means. However, their detrimental properties such as allergic potential, cytotoxicity, antimicrobial resistance, and safety concerns have intrigued researchers over the years to look for safer options. During the past decade, the number of studies has increased utilizing herbs as irrigating solutions. This literature review was conducted to summarize the existing knowledge and provide a comprehensive review of clinical trials on herbal irrigating solutions in pediatric dental patients. An exhaustive literature search was performed in the indexed databases electronically for publications in peer reviewed scientific journals to find the relevant clinical studies evaluating efficacy of herbal root canal irrigants employed in primary teeth.

Introduction: Increased mortality due to sepsis and bacteremia impacts health-care activities severely. Administration of broad-spectrum antibiotics empirically may lead to failure of treatment. Toxic effects of non-susceptible drugs can be harmful for the patients and lead to the development of resistance. Aim: The aim is to study the prevalence of multidrug-resistant Gram-negative bacteria causing bloodstream infections in a tertiary care center. Materials and Methods: A total of 6265 blood samples were received in the Microbiology Department of GB Pant Hospital from January 1, 2018, to December 31, 2018. The samples were processed as per standard techniques. Identification and antimicrobial susceptibility testing were done by VITEK-2 Compact automated system and Kirby–Bauer disc diffusion method as per the Clinical and Laboratory Standards Institute guidelines. Results:Of total 6265 blood culture samples received in laboratory, 480 (7.66%) were culture positive. The Gram-negative bacteria 316 (65.83%) were isolated in majority followed by Gram-positive bacteria 148 (30.83%) and Candida spp. 16 (3.33%). Klebsiella pneumoniae (31.01%) was most common isolate among the Enterobacteriaceae. Whereas among the non-fermenting Gram-negative bacterial isolates, Pseudomonas spp. (17.72%) was most common. Gram-negative bacteria were resistant to commonly used antibiotics. 50–70% resistance was observed against carbapenems. Least resistance was seen to last resort antibiotics, i.e., tigecycline and colistin. Conclusions:The increased isolation of multidrug-resistant Gram-negative bacteria is distressing, and further studies are advocated to help in the formulation of treatment and preventive strategies so as to curb such emergence.

Finite element (FE) model of a square cantilevered plate instrumented with a piezoelectric sensor and an actuator is created using Hamilton’s principle. Rotational degrees of freedom (dofs)...

Background: Empathy is just as relevant within dentistry, although research is limited in this field and very less is available in the current literature. The demonstration of empathy by dentists has been correlated with decreased dental fear. The authors systematically reviewed the literature to investigate empathy levels among dental students. Methods: A systematic review of the literature was undertaken concerning dental students' empathy, published from November 2016 to June 2018, using manual methods and the PubMed, PMC, PsycINFO, and other databases. Articles not in English and not concerned with dentistry were excluded, and intervention studies intended to enhance empathy, opinion articles, and reviews or reports of nonoriginal research were excluded. Eligible studies were those published from January 1, 2005, to May 31, 2017, in English language. A total of 34 full-text articles were obtained and assessed. Of these 34 papers, only seven publications were considered to have met the inclusion criteria and were directly related to the aim of literature search. Results: Only seven articles that provided data and evidence describing empathy among dental students were included. Four studies reported that the difference in mean empathy level across the year of study was statistically significant (P < 0.05), and one reported that there was no significant difference in empathy scores between the year levels of study. Three articles reported that males had higher mean empathy score than females, whereas vice versa was found in the remaining four articles. Conclusion: This article demonstrates that there is only a limited evidence to provide the understanding of empathy among dental students. The results indicated that as patient exposure increases, the empathy level decreases among dental students. Furthermore, it is observed that education in behavioral sciences may be effective in increasing self-reported empathy, and further training may be necessary to maintain high levels.

Background and Purpose: Fungal infections of the central nervous system (CNS) are life-threatening conditions that are frequently misdiagnosed with bacterial and viral CNS infections. Cerebral phaeohyphomycosis is a cerebral infection caused by dematiaceous fungi, especially Cladophialophora bantiana. Very few cases of fungal CNS infection have been reported across the world. High clinical suspicion should be cast for the patients with brain abscess that do not respond to conventional antibiotic therapy.Case report: We report a case of a 21-year-old male presenting with headache, seizures and weakness in the limbs. Radiological examination revealed multiple brain abscesses. After surgical excision and laboratory evaluation, it was found to be caused by C. bantiana. The patient’s outcome was good with surgical excision and voriconazole therapy. Conclusion: Brain abscess caused by C. bantiana is on rise, especially in immunocompromised groups. Thus, high clinical suspicion, accurate diagnosis and management are the fundamentals for good prognosis.

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.

This paper presents a novel technique for Active Vibration Control (AVC) based on updated mathematical model of a mechanical structure. Vibrations of a smart plate instrumented with PZT sensor and actuator are suppressed using a negative velocity feedback controller. The AVC controllers are designed and compared for two cases. In first case it is assumed that there is a mismatch between the analytical model and the actual structure. In the second case the mismatch in analytical model and actual structure is compensated using direct method of model updating. Numerical simulations carried out in MATLAB software for these two cases demonstrate the improvement in performance of the AVC controller when updation is carried out.

Context: Few studies have been published about the in vitro Doripenem susceptibility profiles of Gram negative bacteria obtained from lower respiratory tract samples of patients suffering from Ventilator Associated Pneumonia (VAP). Aims: To generate preliminary data on in vitro Doripenem susceptibility profile of Gram negative bacteria isolated from mucus trap samples of patients suffering from VAP and also compare the organism wise in vitro susceptibility pattern of Doripenem, ertapenem, imipenem and meropenem. Settings and Design: A pilot study was conducted in a super speciality hospital from October 2015 to June 2016. Material and Methods: Patients on ventilator admitted in various intensive care units (ICUs) satisfying the defining criteria for VAP as per standard guidelines were included in the study. Seventy-Seven Gram negative bacterial isolates obtained from mucus trap samples of fifty-seven non-consecutive patients were identified and subjected to antibiotic susceptibility testing (AST) as per standard guidelines. Statistical analysis used: Descriptive statistics. Results: Klebsiella pneumoniae followed by Acinetobacter baumannii and Pseudomonas aeruginosa were the predominant bacterial isolates. The Doripenem resistance rates among K. pneumoniae, A. baumannii and P. aeruginosa were 55.10%, 96.43% and 52.94% respectively. There was 100% concordance between resistance to Doripenem, imipenem and meropenem respectively in A. baumannii. Fourteen (82.35%) out of seventeen Enterobacteriaceae spp. (Klebsiella pneumoniae and Escherichia coli) Doripenem resistant isolates were also resistant to ertapenem, imipenem and meropenem respectively. In case of P. aeruginosa, five (55.55%) Doripenem resistant isolates were also resistant to imipenem and meropenem respectively. Conclusions: This is probably the first report on high level of Doripenem resistance in K.pneumoniae from India. More number of studies should be conducted in order to substantiate our findings

The recent outbreak of nCOVID-19 pandemic has shaken the world. Dentists are at a great risk of contracting and transmitting this fatal disease. However, as health care personnel this is our duty to treat patients especially in emergency situations when treatment is inevitable. Equipping ourselves with adequate knowledge and safety measures will not only protect us but our patients as well. The routes of transmission of nCOVID-19 include direct and indirect contact with the infected person. Dental operatory offers plethora of opportunities for transmission because of the nature of the work done so it is important that clinical management should begin even before the patient enters the dental clinic. Dentist should be aware of the disinfection protocols and proper use of barrier techniques and Personal Protective Equipment (PPE) and about the disposal of the waste generated. [ABSTRACT FROM AUTHOR] Copyright of Journal of Clinical & Diagnostic Research is the property of JCDR Research & Publications Private Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Escherichia coli (E.coli) and Klebsiella pneumoniae (K.pneumoniae) are the most common organisms isolated from clinical specimens. Increasing Multi-Drug Resistance (MDR) in these Gram-negative organisms has caused considerable therapeutic challenges in clinical practice. This has recently revived interest in Colistin as a remedial option. The increasing use of colistin entails the provision of rapid and reliable methods for colistin susceptibility testing. Aim: To evaluate the performance of rapid polymyxin Nordmann-Poirel (NP) test and VITEK-2 for detection of colistin resistance. Materials and Methods: Two methods of colistin susceptibility testing, VITEK-2 and Rapid polymyxin NP test were compared on 310 isolates of E.coli and K.pneumoniae obtained from various clinical samples such as blood, urine, sputum, pus and endotracheal aspirates. Kappa analysis was done to evaluate the percentage agreement between Vitek-2 and Rapid Polymyxin NP tests. Results: Out of 310 isolates, 232 were E.coli and 78 were K.pneumoniae. The results of both the methods were consistent in (237/310) 76.45% cases and non-consistent in (73/310) 23.55% cases. Kappa analysis revealed that the strength of agreement between the two test was considered moderate (kappa=0.412, confidence interval: from 0.312 to 0.513). Conclusion: Rapid polymyxin NP test when compared to VITEK-2 was simple, rapid and cost-effective. Thus, it can be used in laboratories for screening of polymyxin resistance in carbapenemase-producing Gram-negative bacteria as recommended by CLSI (Clinical Laboratory Standard Institute).

This report describes nosocomial blood stream infection caused by Candida auris in a patient with neurological illness in a tertiary care hospital. Blood culture was performed by Bactec and initial identification and sensitivity by VITEK 2. It was misidentified as Candida haemulonii with sensitivity to Caspofungin, Micafungin and Voricanazole. MALDI-TOF analysis on the isolate confirmed it as Candida auris. However, patient was treated with Caspofungin and showed clinical improvement. Thus, multiple automated methods should be employed to accurately diagnose bugs causing life threatening infections.

Background: During the course of health care of patients, thousands of health care workers suffer occupational exposures among which nurses have high chances of exposure to blood-borne pathogens as they are the primary health care providers to patients in hospitals. Post-exposure prophylaxis has become routine following the occupational exposure of HCWs to HIV and HBV. So it is important that nurses keep their knowledge updated regarding handling of HIV and HBV patients and how to manage occupational exposure. Method: A training programme for nurses was conducted by a tertiary care hospital and their knowledge regarding occupational exposure management and handling of HIV and HBV patients was assessed through pre-test and post-test questionnaire. Result: Total 36 clinically registered nurses participated. The mean score of pre-test was 8.7 which increased to 10.1 in post-test. The knowledge related to PEP and handling of HIV and HBV patients improved significantly after the training class (p=0.0001 and 0.002 respectively). Conclusion: The nurses are quite prone for occupational exposure to HIV and HBV and the findings of this study highlight the importance of continuous training of nurses so that they have a comprehensive understanding of PEP and standard precautions. Thorough orientation to the PEP procedure will help them access appropriate medical advice in a timely manner.

Dealing with carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains, which are generally pan-drug resistant, is an uphill task for health care professionals. Owing to limited therapeutic options and the possibility of development of resistance to commonly used biocides in hospital settings, CR-Kp infections pose a serious threat of emergence of a dreaded pandemic. The aim of the study was to highlight the possibility of emergence of biocide resistance among CR-Kp strains. A case study was conducted in a Super-specialty Hospital in September 2015. A 65-year-old female patient post-laparotomy was admitted to the General Intensive Care Unit of a Super-specialty Hospital. CR-Kp was isolated from the blood and mucus trap samples of this patient. Susceptibility testing of three commonly used biocides in our hospital, namely sodium hypochlorite (4% available chlorine), 5% w/v povidone iodine (0.5% w/v of available iodine) and absolute ethanol (99.9%), respectively, was carried out using K. pneumoniae ATCC 700603 as control. The test isolate showed reduced susceptibility to sodium hypochlorite in comparison to K. pneumoniae ATCC 700603. The possibility of emergence of biocide resistance among CR-Kp strains poses a threat of disrupting our ongoing efforts for implementation of effective infection control measures.

Salivary gland tumors account for less than 3% of the head and neck tumors. Among various salivary gland tumors, pleomorphic adenoma is most common and accounts for 60- 70% of the benign tumors of salivary glands. However, the involvement of minor salivary glands of buccal mucosa is extremely uncommon and reported to be 4% only. Salivary glands may present with a diverse range of lesions presenting a challenge to even the most experienced clinician. We report two rare cases of pleomorphic adenoma of minor salivary glands of buccal mucosa in a 45 year old female and 70 years old male respectively. It includes clinical features, diagnosis and treatment of the tumor.

Clinical Microbiologists often come across strange structures during microscopic examination of clinical specimens which are often confused with and misreported as micro-organisms. We studied series of cases in a super speciality hospital from January 2015 to December 2016 with the aim of enumerating artefacts and mimickers that may simulate infectious agents. Microscopic examination of various clinical specimens like pus, tissue, sputum and blood (for peripheral smear examination) received by the department of Microbiology during this period was carried out as per requisition received from clinicians. Photographs of several microscopic artefacts were obtained using a high definition camera. For comparative purpose, photographs of common pathogenic micro-organisms closely resembling these structures were also obtained. Various microscopic artefacts closely resembling pathogenic micro-organisms like fungal hyphae, microfilariae, malaria parasites, acid fast bacilli, budding yeast cells and hooklets of Echinococcus granulosus were observed during the course of this study and enumerated. Owing to paucity of available literature, it is absolutely essential to highlight the issue of misreporting of infectious diseases during microscopic examination of clinical specimens.

Background and Aims: Catheter-associated urinary tract infection (CAUTI) is one of the most common health care acquired infection encountered in clinical practice. The present study was planned to assess the knowledge and attitude of health care providers regarding the indications for catheterization and methods of preventing CAUTI. Methods: A prospective questionnaire-based survey was done from March 2011 to August 2011. A structured questionnaire comprising of 41 items related to demographic details of the respondents, their knowledge regarding indications for catheterization and methods of preventing CAUTI was given to 54 doctors and 105 nurses. The response was evaluated for statistical correlation using a computer software. Results: The mean years of experience of the respondents in the health care setup was 6.8 years. Only 57% of the respondents could identify all the measures for prevention of CAUTI. The knowledge regarding the indication for catheterization though suboptimal was significantly better amongst the doctors as compared to nurses. Conclusion: The knowledge regarding indication and preventive measures was suboptimal in our study group. There is a tremendous scope of improvement in catheterization practices in our hospital and education induced intervention would be the most appropriate effort toward reducing the incidence of CAUTI.