Search

Introduction: India witnessed the catastrophic second wave of COVID-19 during the summer months of 2021. Many patients with non-resolution of symptoms admitted to dedicated COVID-19 treatment centers required prolonged inpatient care which led to the unavailability of beds for other COVID-19 patients. The objective of this study was to determine the duration of SARS-CoV-2 positivity in moderate and severe COVID-19 patients requiring long-term pulmonary care as well as to find out the association between different variables with the persistence of the virus. Methodology: A retrospective chart review of clinical and laboratory data of patients with moderate and severe COVID-19 between 1st April 2021 and 15th July 2021 admitted for more than 28 days and requiring long-term pulmonary care was carried out at National Cancer Institute, AIIMS, India. SARS-CoV-2 RNA was detected with real-time reverse transcriptase-polymerase chain reaction-based tests. Data from all consecutively included patients satisfying the selection criteria were presented temporally and analyzed by Fisher’s exact test (p < 0.05). Results: All 51 patients tested positive for SARS-CoV-2 RNA at the 5th week of initial laboratory confirmation of COVID-19. The majority of the patients (38; 74.5%) remained positive for viral RNA till the 6th week and the median duration of viral positivity was 45 days. The clinical presentation of SARI at admission was significantly higher among patients with viral persistence till the 6th week (p < 0.05). Conclusions: The median duration of the viral positivity was 45 days and SARI at admission was significantly associated with viral persistence till the 6th week.

The present study aimed to determine the utility of detection of co-infection of Gardnerella vaginalis and Atopobium vaginae using qualitative PCR for diagnosing bacterial vaginosis (BV). Vaginal samples (n = 385) categorized as positive (n = 108) or negative (n = 208) for bacterial vaginosis based on the Nugent scoring system, were analyzed for the presence of G. vaginalis and A. vaginae by conventional PCR. We compared the sensitivity, specificity, positive predictive value, negative predictive value and odds ratio for the detection of each bacterium alone with the combination of the two bacteria for diagnosing BV. The detection of co-infection of the two bacteria demonstrated a sensitivity of 96%, a specificity of 82.9%, a positive predictive value of 68.5%, a negative predictive value of 98.2% with an odds ratio of 116 (CI -32 - 409). In our study, we found a high sensitivity, specificity, negative predictive value and odds ratio for the detection of co-infection of A. vaginae and G. vaginalis for the diagnosis of BV.

INTRODUCTION: Resistance to antimicrobial agents is a major concern worldwide and is exemplified by the global spread of the Methicillin resistant Staphylococcus aureus (MRSA). Health care workers (HCWs) and asymptomatically colonized patients are important sources of nosocomial MRSA infections. AIMS AND OBJECTIVES: To determine the prevalence of MRSA colonisation, two hundred HCWs and 200 consecutive outpatients attending our tertiary care hospital were studied. MATERIALS AND METHODS: Two sterile pre-moistened cotton tipped swabs were used to collect specimens from their anterior nares. These were inoculated immediately on Blood agar with oxacillin, Mannitol salt agar with oxacillin and CHROM agar. Resistance to cefoxitin was confirmed by PCR by demonstration of mecA gene. Antibiotic susceptibility was determined by Kirby Bauer’s disc diffusion method and MIC of vancomycin by using broth dilution and Vitek-2 Compact system. RESULTS: The nasal carriage of MRSA among HCWs was found to be 7.5% and in outpatients 3%. All strains of MRSA from HCWs and outpatients grew on three selective media and mecA gene amplified in all of them. All the isolated strains of MRSA showed high degree of resistance to co-trimoxazole (93.3%), ciprofloxacin (80%) and erythromycin (66.66%). However, there was 100% susceptiability to vancomycin, teicoplanin, linezolid and Rifampicin. CONCLUSION: Although a direct casual relationship could not be established, it could be assumed that the transmission from colonised health care worker is responsible atleast in part for MRSA infection among patients. Therefore emphasis should be laid on strict implementation of standard infection control practices which would help in minimizing the carriage and transmission of MRSA in the hospital.

Introduction: Fever with thrombocytopenia is a common condition that is associated with an increased risk of morbidity and mortality. Aims & Objectives: The study was designed to assess the etiology, clinical features and laboratory profile of fever with thrombocytopenic patients which is of great value in determining the outcome and prognosis in thesepatients. Material & Methods: A total number of 50 patients who were admitted with the history of fever with thrombocytopenia were studied. Detailed examination of various systems was done. Routine investigations were done, Specific and Special investigations (Blood &Urine culture, Widal, Antigen test for malaria, IgM ELISA Dengue, Bone marrow examination etc.,) were done as and when indicated. Results:From this study it was observed that infections (98%) were the most common cause and among infections malaria (36%)was the commonest cause followed by viral illness (34%).Definitive increase in platelet counts was noted after treating the underlying cause. Conclusion: Thrombocytopenia was the commonest laboratory finding in many fever cases.It is better to do platelet count in all fever cases whether they have bleeding manifestations or not.

Septic arthritis is one of the most serious conditions leading to grave consequences in all age groups, with a number of cases seen in infancy and childhood. Although septic arthritis in neonates is a known clinical entity, it is a diagnostic dilemma for the paediatricians. Of the reported causes of bacterial arthritis, anaerobic bacteria account for only 1%. Anaerobic bacterial septic arthritis may be more common than appreciated and therefore anaerobic as well as aerobic cultures should be done in all cases of septic arthritis. We report the first documented case of spontaneous septic arthritis due to Clostridium septicum in an infant with successful outcome.

Introduction: Human Papillomavirus (HPV), a small circular double stranded DNA virus is the major aetiological agent of cervical precancerous and cancerous lesions. Genital HPV types are divided into high and low risk types, according to their oncogenic potential. The proportion of women infected with HPV varies greatly across populations as is the distribution of HPV genotypes. Aim: The present pilot study was conducted to determine the most frequent genotypes of HPV associated with: a) Histologically proven cases of cervical carcinoma; b) Women with normal cervical cytology. Materials and Methods: The present hospital based crosssectional study was conducted on 132 women attending Obstetrics and Gynaecology department of a tertiary care hospital. Consecutive cervical brushings were collected from women presenting with any type of cervical lesion and were subjected to cytology, histopathological examination, HPV DNA testing and genotyping by using Sacace real time PCR. Results: Of the 132 women studied between January 2014- October 2014, 50 (37.87%) had histologically proven cervical carcinoma and 82 (62.12%) had normal cytology. In proven cases of cervical carcinoma, HPV infection was found to be associated in 49/50 (98%) and all of them had high risk HPV genotypes. The most common genotypes were 16 (67.34%) and 18 (20.4%). Other genotypes present were 45 and 33. Out of 82 cytological normal women, five showed presence of HPV DNA on RT PCR. While all the five had infection of HPV genotype 18, in one there was presence of both 16 and 18 genotypes. Conclusion: The detection of HPV genotypes 16, 18 along with high risk type 33 and 45 in Malwa region of Punjab confirm the importance of identifying the types of HPV that infects this community to design more effective prevention strategies and thus contribute to fight against cervical cancer.

Sir, Methicillin resistant Staphylococcus aureus (MRSA) has emerged as a dangerous pathogen of hospital acquired infection and is also spreading in the community1,2. We report here data on this infection from a teaching hospital located in North-West India. During 2012-2013, a total of 248 Staphylococcus aureus isolates obtained from various clinical specimens like pus, blood, urine, body fluids, catheter tips etc. Of the patients visiting Guru Gobind Singh Medical College (GGSMC) and Hospital, Faridkot, Punjab, India, were studied. Of these, 161 (64.9%) were detected as MRSA and 87 (35%) as methicillin sensitive Staphylococcus aureus (MSSA) by observing their resistance to cefoxitin (30 µg) disc3. Further confirmation of methicillin resistance was done by demonstration of mecA gene by PCR4. Overall, MRSA was found in 64.9 per cent (161/248) samples which was higher than the prevalence reported in Indian Network of Surveillance of Antimicrobial Resistance (INSAR) study (41%)1 but was in the range (22 to 68%) observed by various centres participated in the study1. The MRSA increased from 60.5 per cent (92/152) in 2012 to 71.8 per cent (69/96) in 2013, but the difference was not significant. Similar increase has also been reported by six of the 15 tertiary care centres during the two years period (January 2008 to December 2009) of the surveillance1. In our study, the isolation rates of MRSA from non-ICU inpatients (50% in 2012; 69.6% in 2013) were higher than that of outpatients (29.3% in 2012; 18.8% in 2013) and ICU patients (20.7% in 2012; 13% in 2013). This was in contrast to the INSAR study where the isolation rates of MRSA were maximum from ICU followed by non-ICU inpatients and outpatients1. The study of S. aureus isolates from various clinical specimens at our centre showed that maximum isolates were from skin and soft tissue infections followed by blood stream infections and respiratory infections. Susceptibility to various antibiotics is shown in the Table. Similar to the various studies of the INSAR surveillance1, we observed that MRSA isolates were more resistant to antimicrobial agents in comparison to MSSA. However, this difference was not significant for erythromycin, clindamycin, gentamicin and ciprofloxacin. However, for ampicillin and co-trimoxazole the difference was found to be significant (P

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent significant public health issues globally. They are important causes of morbidity and mortality in hemodialysis patients. Patients with HBV/HCV co-infection have a higher risk of progression to cirrhosis and decompensated liver disease and have an increased risk of hepatocellular cancer (HCC). Because the two hepatotropic viruses share same modes of transmission, co-infection with the two viruses is not uncommon, especially in areas with a high prevalence of HCV infection and among people at high-risk for parenteral infection. Aims: To estimate the prevalence of HBV and HCV co-infection among hemodialysis patients. Materials and Methods: This retrospective, single centered hospital record-based study was carried out in a tertiary care hospital in Faridkot (Punjab), India. All the patients who underwent hemodialysis from January 2013 to December 2014 were included in the study. Patients of all age groups were tested for anti-HCV antibodies by fourth Generation HCV Tridot ELISA (J. Mitra & Co. Pvt. Ltd., New Delhi, India) and for hepatitis B surface antigen (HBsAg) by Hepalisa (J. Mitra & Co. Pvt. Ltd). Results: Of the total 262 patients on hemodialysis, 88 (33.5%) were found to be having HCV infection, 4 (1.5%) were found to be positive for HBsAg. Co-infection with HBV/HCV was observed in 2 (0.8%) patients. Out of the total 92 patients having HBV and HCV infection, 62 (67.4%) were males and 30 (32.6%) were females. The majority of the patients were found to be of 41-60 years of age (41.3%) followed by 21-40 years (31.5%) and thereafter in 61-80 years (23.9%) and lowest prevalence was observed in the age group of 80 years (1.1%). Conclusion: The risk of co-infection is greater among the chronic renal failure (CRF) patients due to the high frequency of transfusions of blood/blood products and extracorporeal circulation during hemodialysis. Patients with HBV/HCV co-infection have a higher risk of progression to cirrhosis and decompensated liver disease and further have an increased risk of HCC. In our study, out of the total 262 patients, 88 (33.5%) were found to be having HCV infection, 4 (1.5%) were found to be positive for HBsAg and dual infection was observed in 2 (0.8%) patients which is higher than the rates reported from different studies all over the world and India.

Nevus of Ota, blue hyperpigmentation along the first and second branches of trigeminal nerve involves face, forehead, eyebrows, nose and eye (especially sclera). Late onset adulthood presentation, a rare presentation, represents stimulation by amelanotic melanocytes by potent stimuli like female sex hormones, trauma, infection. This condition in late onset, warrants detail investigations to rule out other associated autoimmune disorders and malignant change of nevus. This case highlights the importance of recognizing this entity even when the onset is late.