Health Sciences

Accuracy of preoperative ultrasonography in measuring tumor thickness and predicting the incidence of cervical lymph node metastasis in oral cancer N Hareesh Babu, B Vijaya Lakshmi Devi, Silpa Kadiyala, AY Lakshmi, H Narendra, N Rukmangadha Journal of Dr. NTR University of Health Sciences 2018 7(4):241-244 Context: A major determinant of the prognosis of oral cancer is the risk of cervical lymph node metastasis. Several factors have been assessed preoperatively to predict the risk of lymph node metastasis; among them, tumor thickness is proved to be a significant predictor of lymph node metastasis. Ultrasonography (US) is a noninvasive, rapid, easily repeatable, and economical examination to measure tumor thickness. This study is undertaken for evaluating the usefulness of US to predict neck metastasis. Aim: To measure tumor thickness in oral cancer with preoperative US and to predict occult cervical lymph node metastasis. Materials and Methods: In all, 43 patients with biopsy-proven squamous cell carcinoma of tongue/buccal mucosa underwent preoperative US to measure tumor thickness. Statistical Analysis: Tumor thickness from histolopathology and US was analyzed using Pearson's product moment correlation. Fisher's exact test was used to assess the relationship between tumor thickness and the risk of cervical lymph node metastasis. Results: There was a significant correlation between preoperative US and histological measures of tumor thickness (correlation coefficient 0.961, P < 0.001). The overall rate of lymph node metastasis was 25.5% (11/43). In the group with tumors <5 mm in thickness, the neck metastatic rate was 0% (0/5), when compared with 29% (11/38) in the group ≥5 mm. There is difference between the two groups, but it was not statistically significant, P > 0.05. Conclusion: Preoperative US is an accurate measure of maximal tumor thickness. Tumor thickness ≥5 mm can be considered as a risk factor for cervical lymph nodal metastasis.

Birth asyphxia: Looking at trends of risk factors leading to birth asphyxia in a peripheral hospital Anantsagar Motepalli, Manisha Ramanlal Patel, Venkateswara Rao Journal of Dr. NTR University of Health Sciences 2018 7(4):245-248 Objectives: To look at the trends of risk factors leading to birth asphyxia, in newborns admitted to a peripheral hospital giving tertiary care. Methodology: Descriptive longitudinal study conducted over a period of 6 months (March 2016–August 2016) in babies fulfilling the criteria for birth asphyxia. Variables studied included antenatal care (ANC), period of gestation, place of delivery, mode of delivery, birth weight, pregnancy complication, and time of arrival to hospital. Results: The total number of admission in neonatal unit during the study period was 540, of which 58 babies fulfilled the inclusion criteria for birth asphyxia. The majority of admissions were referred from government hospital (68.91%), and all the mothers were booked and had ANC visits. Similarly, all were full terms except one preterm baby. Caesarean section was performed in 25.8%, and 74.2% had normal vaginal delivery. All were institutional/hospital delivery. The majority (65%) of babies were referred within 6 h, and 79.3% of babies weighed more than 2.5 kg. Conclusion: Birth asphyxia occurring in such a high number of booked cases with institutional/hospital delivery indicates inadequate perinatal services. It is advisable to have trained neonatal resuscitation personnel with all necessary equipments and medications at the time of delivery.

Left transverse loop colostomy versus high sigmoid loop colostomy for high-type anorectal malformations: Early outcome analysis Sharanabasappa Gubbi, Rahul Gupta, Arun K Gupta, Arvind K Shukla Journal of Dr. NTR University of Health Sciences 2018 7(4):249-253 Background: High sigmoid (divided) colostomy has been recommended by various studies for the management of high-type anorectal malformation (ARM). It is postulated to be associated with fewer complications. Aims: To compare the complications related to left transverse loop colostomy and high sigmoid loop colostomy done in male patients with high-type ARM and share our experience. Materials and Methods: A prospective study on all male neonates admitted with high-type ARM at our high-volume tertiary care institute from January 2014 to March 2016 was carried out. The patients were randomized and divided into two groups (group A: left transverse loop colostomy and group B: high sigmoid loop colostomy). The patient's clinical presentation, operative course, and complications were recorded. Results: Of 158 male neonates who were subjected to loop colostomy, 93 (58.9%) were in group A and 65 (41.1%) in group B. Mortality was higher in group B (16.9%) than group A (8.6%), but none directly related to the type of colostomy. Intraoperative complications (technical difficulties) such as difficulty in approaching the sigmoid colon with dilated small bowel loops and identifying the proximal and distal parts of sigmoid colon along with handling of the bowel (including serosal tears) were significantly more in group B (20%) than group A (1.07%) where transverse colon was easily exteriorized. The average time taken for the procedure, pericolostomy excoriation, and bowel obstruction was more in group B when compared with group A. Conclusion: Left transverse loop colostomy works well to relieve the obstruction and is less time-consuming, particularly with late presentation. We recommend left transverse loop colostomy in cases of high-type male ARM because of the ease of procedure and comparatively low complication rates.

Pemphigus foliaceus: Clinicoepidemiological study at tertiary care center Sudha Rani Chintagunta, Srinivas Manchala, Geetakiran Arakkal, Bhavya Sindhu Jayanthi, Bareen Waseem Kabir Journal of Dr. NTR University of Health Sciences 2018 7(4):254-258 Background: Pemphigus foliaceus (PF) is characterized by shallow erosions with erythema, scaling, and crusting over seborrheic areas of the face, scalp, and chest with characteristic histopathology and direct immunofluorescence (DIF). Aim: To study the clinicoepidemiological profile of patients with PF and response to treatment, especially pulse therapy. Materials and Methods: This was a prospective clinical and therapeutic study of 20 patients WITH PF, attending DVL Department, from May 2007 to April 2016. The diagnosis was made based on clinical features, histopathology, and DIF. Clinical variants of PF were studied, and severity was assessed based on body surface area involvement. After detailed evaluation, 18 patients started on pulse therapy [13 dexamethasone cyclophosphamide pulse (DCP), 3 dexamethasone azathioprine pulse (DAP), 2 dexamethasone-only pulse (DOP)]. Two patients were not started on pulse therapy for medical reasons. Results: The most common age group affected was 51–60 years. Male: female ratio was 1:1. Clinical variants observed were classical localized – 4, classical generalized – 10, erythrodermic – 4, pemphigus erythematosus – 1, and acral vesiculopustular lesions – 1. Nail changes and small erosion on the inner aspect of the lower lip were present in two patients each. The average time to remission was 7.3 months. Of 18 patients, 14 patients responded well to DCP/DAP/DOP therapy. Two patients lost to follow-up in phase 1. Two patients had frequent relapses and started on methotrexate; the disease is under control in one patient. Conclusion: PF usually localized to seborrheic areas; in our study, generalized papulosquamous lesions and erythroderma-like presentation were predominant. The majority of the patients showed remission with pulse therapy, and two patients require addition of immunosuppressants in the follow-up period.

Pustular psoriasis – Clinical study in a tertiary care center Sudha Rani Chintagunta, Sudha Vani Damarla, Prema Jyothi Gopidi, Geetakiran Arakkal Journal of Dr. NTR University of Health Sciences 2018 7(4):259-264 Background: Pustular psoriasis is an uncommon form of psoriasis consisting of sheets of pustules on erythematous background. Treatment depends on the extent of involvement, severity, and underlying risk factors. Objectives: To study the clinical profile of pustular psoriasis, to identify triggering factors, and to study the response to treatment. Materials and Methods: A prospective clinical and therapeutic study of patients with pustular psoriasis attending DVL department over a period of 2 years. Diagnosis was made based on clinical and histopathological findings. Fourteen patients were admitted, investigated, and treated appropriately. Results: Nine were females and five were males. The mean age of the patients was 30 years. The duration of disease was 1–3 weeks. Among 14 cases of generalized pustular psoriasis, 10 were of acute type, 3 were pregnancy-related, and 1 childhood onset. In pregnancy group, all the patients were managed with systemic steroids till delivery followed by methotrexate (Mtx) and cyclosporine (CsA) during postpartum period in two patients, respectively. Eight patients were managed with short course of steroids and Mtx followed by Mtx alone. One patient with tuberculosis spine was managed with CsA and antituberculous therapy. Highly active retroviral therapy and acitretin (50 mg) were given in a retroviral-positive patient. One patient with recurrent episodes improved with antibiotics only. In our study, steroids were followed by maintenance therapy with Mtx/CsA and acitretin accordingly. CsA was given during crisis followed by maintenance with acitretin. Two patients on Mtx and one on CsA therapy with frequent flares were shifted to acitretin. Acitretin showed good response in patients who had frequent flares while on Mtx and CsA. In our study, response with acitretin, Mtx, and CsA was 100%, 57.1%, and 50%, respectively. Limitations: Only small number of patients. Conclusion: All patients were generalized type and showed good remission except one who succumbed to death due to septicemia.

Estimation of midkine levels in serum and gingival crevicular fluid in smokers and non-smokers of chronic gingivitis patients – A clinico-biochemical study Dandu Subramanyam Madhu Babu, Sundeep Narahari, Vineetha Vemuri, Egatela Prasuna, Dandu Siva Sai Prasad Reddy, Nagireddy Ravindra Reddy Journal of Dr. NTR University of Health Sciences 2018 7(4):265-271 Objectives: To detect the presence of Midkine in serum and gingival crevicular fluid (GCF) of healthy non-smokers, chronic gingivitis smokers, and non-smoker individuals and to evaluate the role of Midkine in the progression of gingival inflammation. Materials and Methods: Periodontal clinical parameters examination including gingival index, pocket probing depth, clinical attachment level, and collection of GCF and serum was performed on 60 subjects, categorized into three groups with 20 subjects in each group: Group I (healthy non-smokers); Group II (chronic gingivitis non-smokers), and Group III (chronic gingivitis smokers). GCF and serum were collected from 20 patients of each group. Midkine levels were estimated using the enzyme-linked immunosorbent assay. Results: Midkine was detected in all samples. The results of this study suggest that mean GCF and serum Midkine levels were the highest in Group III and varied significantly from those of Groups I and II. Furthermore, GCF and serum Midkine levels increased proportionally with the progression of inflammation. Conclusion: As the gingival disease progresses, there is a substantial increase of Midkine concentrations in serum and GCF. Since, Midkine levels in the GCF and serum correlated positively with clinical parameters, Midkine may be considered as a “novel biomarker” in disease progression. However, controlled longitudinal studies are required to confirm this possibility.

Is cashew nut shell liquid a causative factor for oral submucous fibrosis?. A study among cashew nut industrial workers Vijayakumar Anu, Parangimalai Diwakar Madan Kumar, MahadevaShastry Shivakumar Journal of Dr. NTR University of Health Sciences 2018 7(4):272-275 Background: Cashew nut shell liquid contains 90% anacardic acid and 10% cardol. This liquid when comes in contact topically is said to have deleterious effects both orally and systemically. Aim: The present cross-sectional study was conducted to assess the prevalence of oral submucous fibrosis (OSMF) among 600 cashew nut industrial workers in Kanyakumari district. Materials and Methods: Demographic data and tobacco habits were assessed using pretested questionnaire. Ranganathan K clinical grading system was used to examine OSMF. The data were assessed using SPSS version 11.5. Results: The overall prevalence of OSMF among the study population was 0.002%. Conclusion: The observation from this study clearly indicates that safe working environment prevents occupational hazards.

Orthodontic uprighting of severely impacted mandibular permanent second molar with TMA spring Revathi Peddu, Bhargavi Nuvusetty, Aruna Dokku, L Devikanth Journal of Dr. NTR University of Health Sciences 2018 7(4):276-280 Treating impacted teeth is very challenging for an orthodontist. Although canine impactions are common, second molar impactions are also encountered in orthodontics. The fate of impacted second molar depends on various factors such as the degree of its inclination and position of third molars. A case of molar uprighting using a 0.017″ × 0.025″ titanium molybdenum alloy uprighting spring is discussed in this case report. Treatment included surgical exposure and crown lengthening along with orthodontically assisted eruption.

Ameloblastic fibro-odontoma or complex adontoma: A diagnostic dilemma? K Vinay Kumar Reddy, Kotya Naik Maloth, Modali Venkata Lakshmi, Moni Thakur Journal of Dr. NTR University of Health Sciences 2018 7(4):281-284 Ameloblastic fibro-odontoma is a rare benign mixed odontogenic tumor exhibiting the histologic characteristics of ameloblastic fibroma and complex odontoma. Clinically, it represents a well-defined asymptomatic swelling with deformity of face, and radiographically a well-defined radiolucent area, which contains radiopaque foci of various sizes and shapes. These features overlap with other lesions such as calcifying odontogenic cyst, calcifying epithelial odontogenic tumor, and adenomatoid odontogenic tumor which makes a diagnostic dilemma for oral clinicians. Hereby we report such a rare case in a 7-year-old boy.

Unusual cause of chest trauma: Case report of wild boar attack KP Singaravelu, Vinay R Pandit, Ramaprakasha Saya, V Nagasubramanyam Journal of Dr. NTR University of Health Sciences 2018 7(4):285-287 Boar attack to human is uncommon in India and rarely seen in emergency departments. The usual site of injury in such attacks is lower limbs. We report a case of a wild boar attack with penetrating chest injury.  ORIGINAL ARTICLES   Accuracy of preoperative ultrasonography in measuring tumor thickness and predicting the incidence of cervical lymph node metastasis in oral cancer  p. 241 N Hareesh Babu, B Vijaya Lakshmi Devi, Silpa Kadiyala, AY Lakshmi, H Narendra, N Rukmangadha DOI:10.4103/JDRNTRUHS.JDRNTRUHS_27_18   Context: A major determinant of the prognosis of oral cancer is the risk of cervical lymph node metastasis. Several factors have been assessed preoperatively to predict the risk of lymph node metastasis; among them, tumor thickness is proved to be a significant predictor of lymph node metastasis. Ultrasonography (US) is a noninvasive, rapid, easily repeatable, and economical examination to measure tumor thickness. This study is undertaken for evaluating the usefulness of US to predict neck metastasis. Aim: To measure tumor thickness in oral cancer with preoperative US and to predict occult cervical lymph node metastasis. Materials and Methods: In all, 43 patients with biopsy-proven squamous cell carcinoma of tongue/buccal mucosa underwent preoperative US to measure tumor thickness. Statistical Analysis: Tumor thickness from histolopathology and US was analyzed using Pearson's product moment correlation. Fisher's exact test was used to assess the relationship between tumor thickness and the risk of cervical lymph node metastasis. Results: There was a significant correlation between preoperative US and histological measures of tumor thickness (correlation coefficient 0.961, P < 0.001). The overall rate of lymph node metastasis was 25.5% (11/43). In the group with tumors <5 mm in thickness, the neck metastatic rate was 0% (0/5), when compared with 29% (11/38) in the group ≥5 mm. There is difference between the two groups, but it was not statistically significant, P > 0.05.Conclusion: Preoperative US is an accurate measure of maximal tumor thickness. Tumor thickness ≥5 mm can be considered as a risk factor for cervical lymph nodal metastasis. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Birth asyphxia: Looking at trends of risk factors leading to birth asphyxia in a peripheral hospital p. 245 Anantsagar Motepalli, Manisha Ramanlal Patel, Venkateswara Rao DOI:10.4103/JDRNTRUHS.JDRNTRUHS_100_17   Objectives: To look at the trends of risk factors leading to birth asphyxia, in newborns admitted to a peripheral hospital giving tertiary care. Methodology: Descriptive longitudinal study conducted over a period of 6 months (March 2016–August 2016) in babies fulfilling the criteria for birth asphyxia. Variables studied included antenatal care (ANC), period of gestation, place of delivery, mode of delivery, birth weight, pregnancy complication, and time of arrival to hospital. Results: The total number of admission in neonatal unit during the study period was 540, of which 58 babies fulfilled the inclusion criteria for birth asphyxia. The majority of admissions were referred from government hospital (68.91%), and all the mothers were booked and had ANC visits. Similarly, all were full terms except one preterm baby. Caesarean section was performed in 25.8%, and 74.2% had normal vaginal delivery. All were institutional/hospital delivery. The majority (65%) of babies were referred within 6 h, and 79.3% of babies weighed more than 2.5 kg. Conclusion: Birth asphyxia occurring in such a high number of booked cases with institutional/hospital delivery indicates inadequate perinatal services. It is advisable to have trained neonatal resuscitation personnel with all necessary equipments and medications at the time of delivery. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Left transverse loop colostomy versus high sigmoid loop colostomy for high-type anorectal malformations: Early outcome analysis p. 249 Sharanabasappa Gubbi, Rahul Gupta, Arun K Gupta, Arvind K Shukla DOI:10.4103/JDRNTRUHS.JDRNTRUHS_73_18   Background: High sigmoid (divided) colostomy has been recommended by various studies for the management of high-type anorectal malformation (ARM). It is postulated to be associated with fewer complications. Aims: To compare the complications related to left transverse loop colostomy and high sigmoid loop colostomy done in male patients with high-type ARM and share our experience. Materials and Methods:A prospective study on all male neonates admitted with high-type ARM at our high-volume tertiary care institute from January 2014 to March 2016 was carried out. The patients were randomized and divided into two groups (group A: left transverse loop colostomy and group B: high sigmoid loop colostomy). The patient's clinical presentation, operative course, and complications were recorded. Results: Of 158 male neonates who were subjected to loop colostomy, 93 (58.9%) were in group A and 65 (41.1%) in group B. Mortality was higher in group B (16.9%) than group A (8.6%), but none directly related to the type of colostomy. Intraoperative complications (technical difficulties) such as difficulty in approaching the sigmoid colon with dilated small bowel loops and identifying the proximal and distal parts of sigmoid colon along with handling of the bowel (including serosal tears) were significantly more in group B (20%) than group A (1.07%) where transverse colon was easily exteriorized. The average time taken for the procedure, pericolostomy excoriation, and bowel obstruction was more in group B when compared with group A. Conclusion: Left transverse loop colostomy works well to relieve the obstruction and is less time-consuming, particularly with late presentation. We recommend left transverse loop colostomy in cases of high-type male ARM because of the ease of procedure and comparatively low complication rates. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Pemphigus foliaceus: Clinicoepidemiological study at tertiary care center p. 254 Sudha Rani Chintagunta, Srinivas Manchala, Geetakiran Arakkal, Bhavya Sindhu Jayanthi, Bareen Waseem Kabir DOI:10.4103/JDRNTRUHS.JDRNTRUHS_34_17   Background: Pemphigus foliaceus (PF) is characterized by shallow erosions with erythema, scaling, and crusting over seborrheic areas of the face, scalp, and chest with characteristic histopathology and direct immunofluorescence (DIF). Aim: To study the clinicoepidemiological profile of patients with PF and response to treatment, especially pulse therapy. Materials and Methods: This was a prospective clinical and therapeutic study of 20 patients WITH PF, attending DVL Department, from May 2007 to April 2016. The diagnosis was made based on clinical features, histopathology, and DIF. Clinical variants of PF were studied, and severity was assessed based on body surface area involvement. After detailed evaluation, 18 patients started on pulse therapy [13 dexamethasone cyclophosphamide pulse (DCP), 3 dexamethasone azathioprine pulse (DAP), 2 dexamethasone-only pulse (DOP)]. Two patients were not started on pulse therapy for medical reasons. Results: The most common age group affected was 51–60 years. Male: female ratio was 1:1. Clinical variants observed were classical localized – 4, classical generalized – 10, erythrodermic – 4, pemphigus erythematosus – 1, and acral vesiculopustular lesions – 1. Nail changes and small erosion on the inner aspect of the lower lip were present in two patients each. The average time to remission was 7.3 months. Of 18 patients, 14 patients responded well to DCP/DAP/DOP therapy. Two patients lost to follow-up in phase 1. Two patients had frequent relapses and started on methotrexate; the disease is under control in one patient. Conclusion: PF usually localized to seborrheic areas; in our study, generalized papulosquamous lesions and erythroderma-like presentation were predominant. The majority of the patients showed remission with pulse therapy, and two patients require addition of immunosuppressants in the follow-up period. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Pustular psoriasis – Clinical study in a tertiary care center p. 259 Sudha Rani Chintagunta, Sudha Vani Damarla, Prema Jyothi Gopidi, Geetakiran Arakkal DOI:10.4103/JDRNTRUHS.JDRNTRUHS_109_17   Background: Pustular psoriasis is an uncommon form of psoriasis consisting of sheets of pustules on erythematous background. Treatment depends on the extent of involvement, severity, and underlying risk factors. Objectives: To study the clinical profile of pustular psoriasis, to identify triggering factors, and to study the response to treatment. Materials and Methods: A prospective clinical and therapeutic study of patients with pustular psoriasis attending DVL department over a period of 2 years. Diagnosis was made based on clinical and histopathological findings. Fourteen patients were admitted, investigated, and treated appropriately. Results: Nine were females and five were males. The mean age of the patients was 30 years. The duration of disease was 1–3 weeks. Among 14 cases of generalized pustular psoriasis, 10 were of acute type, 3 were pregnancy-related, and 1 childhood onset. In pregnancy group, all the patients were managed with systemic steroids till delivery followed by methotrexate (Mtx) and cyclosporine (CsA) during postpartum period in two patients, respectively. Eight patients were managed with short course of steroids and Mtx followed by Mtx alone. One patient with tuberculosis spine was managed with CsA and antituberculous therapy. Highly active retroviral therapy and acitretin (50 mg) were given in a retroviral-positive patient. One patient with recurrent episodes improved with antibiotics only. In our study, steroids were followed by maintenance therapy with Mtx/CsA and acitretin accordingly. CsA was given during crisis followed by maintenance with acitretin. Two patients on Mtx and one on CsA therapy with frequent flares were shifted to acitretin. Acitretin showed good response in patients who had frequent flares while on Mtx and CsA. In our study, response with acitretin, Mtx, and CsA was 100%, 57.1%, and 50%, respectively. Limitations: Only small number of patients. Conclusion: All patients were generalized type and showed good remission except one who succumbed to death due to septicemia. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Estimation of midkine levels in serum and gingival crevicular fluid in smokers and non-smokers of chronic gingivitis patients – A clinico-biochemical study p. 265 Dandu Subramanyam Madhu Babu, Sundeep Narahari, Vineetha Vemuri, Egatela Prasuna, Dandu Siva Sai Prasad Reddy, Nagireddy Ravindra Reddy DOI:10.4103/JDRNTRUHS.JDRNTRUHS_43_18   Objectives: To detect the presence of Midkine in serum and gingival crevicular fluid (GCF) of healthy non-smokers, chronic gingivitis smokers, and non-smoker individuals and to evaluate the role of Midkine in the progression of gingival inflammation. Materials and Methods: Periodontal clinical parameters examination including gingival index, pocket probing depth, clinical attachment level, and collection of GCF and serum was performed on 60 subjects, categorized into three groups with 20 subjects in each group: Group I (healthy non-smokers); Group II (chronic gingivitis non-smokers), and Group III (chronic gingivitis smokers). GCF and serum were collected from 20 patients of each group. Midkine levels were estimated using the enzyme-linked immunosorbent assay. Results: Midkine was detected in all samples. The results of this study suggest that mean GCF and serum Midkine levels were the highest in Group III and varied significantly from those of Groups I and II. Furthermore, GCF and serum Midkine levels increased proportionally with the progression of inflammation. Conclusion: As the gingival disease progresses, there is a substantial increase of Midkine concentrations in serum and GCF. Since, Midkine levels in the GCF and serum correlated positively with clinical parameters, Midkine may be considered as a "novel biomarker" in disease progression. However, controlled longitudinal studies are required to confirm this possibility. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Is cashew nut shell liquid a causative factor for oral submucous fibrosis?. A study among cashew nut industrial workers p. 272 Vijayakumar Anu, Parangimalai Diwakar Madan Kumar, MahadevaShastry Shivakumar DOI:10.4103/JDRNTRUHS.JDRNTRUHS_101_17   Background: Cashew nut shell liquid contains 90% anacardic acid and 10% cardol. This liquid when comes in contact topically is said to have deleterious effects both orally and systemically. Aim: The present cross-sectional study was conducted to assess the prevalence of oral submucous fibrosis (OSMF) among 600 cashew nut industrial workers in Kanyakumari district. Materials and Methods: Demographic data and tobacco habits were assessed using pretested questionnaire. Ranganathan K clinical grading system was used to examine OSMF. The data were assessed using SPSS version 11.5. Results: The overall prevalence of OSMF among the study population was 0.002%. Conclusion: The observation from this study clearly indicates that safe working environment prevents occupational hazards. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CASE REPORTS Orthodontic uprighting of severely impacted mandibular permanent second molar with TMA spring p. 276 Revathi Peddu, Bhargavi Nuvusetty, Aruna Dokku, L Devikanth DOI:10.4103/JDRNTRUHS.JDRNTRUHS_31_18   Treating impacted teeth is very challenging for an orthodontist. Although canine impactions are common, second molar impactions are also encountered in orthodontics. The fate of impacted second molar depends on various factors such as the degree of its inclination and position of third molars. A case of molar uprighting using a 0.017″ × 0.025″ titanium molybdenum alloy uprighting spring is discussed in this case report. Treatment included surgical exposure and crown lengthening along with orthodontically assisted eruption. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Ameloblastic fibro-odontoma or complex adontoma: A diagnostic dilemma? p. 281 K Vinay Kumar Reddy, Kotya Naik Maloth, Modali Venkata Lakshmi, Moni Thakur DOI:10.4103/JDRNTRUHS.JDRNTRUHS_45_17   Ameloblastic fibro-odontoma is a rare benign mixed odontogenic tumor exhibiting the histologic characteristics of ameloblastic fibroma and complex odontoma. Clinically, it represents a well-defined asymptomatic swelling with deformity of face, and radiographically a well-defined radiolucent area, which contains radiopaque foci of various sizes and shapes. These features overlap with other lesions such as calcifying odontogenic cyst, calcifying epithelial odontogenic tumor, and adenomatoid odontogenic tumor which makes a diagnostic dilemma for oral clinicians. Hereby we report such a rare case in a 7-year-old boy. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Unusual cause of chest trauma: Case report of wild boar attack p. 285 KP Singaravelu, Vinay R Pandit, Ramaprakasha Saya, V Nagasubramanyam DOI:10.4103/JDRNTRUHS.JDRNTRUHS_86_17   Boar attack to human is uncommon in India and rarely seen in emergency departments. The usual site of injury in such attacks is lower limbs. We report a case of a wild boar attack with penetrating chest injury. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Ulcerative lichen planus of lower lip – Case series p. 288 Sudha Rani Chintagunta, Sri Nitya Sana, Prema Jyothi Gopidi DOI:10.4103/JDRNTRUHS.JDRNTRUHS_64_18   Lichen planus (LP) involving lips is a rare occurrence. It can occur isolated or with cutaneous or oral lesions. Clinical features include radiated streaks, lace-like papules, and erosions, usually confined to vermilion border. When isolated, it should be differentiated from cheilitis, discoid lupus erythematosus, and other ulcerative conditions. Herein, we report nine cases of LP involving lower lip, with persistent ulceration and crusting. Of the nine patients in our series, eight were females and one was male. Age varied from 25 to 44 years, and the average duration was 4 years. Cutaneous examination revealed diffuse involvement of the lower lip with ulceration, hemorrhagic crusting in eight and localized involvement in one. Biopsy was suggestive of LP with no dysplasia or malignancy. Treatment with topical corticosteroids, tacrolimus, sunscreens, and Hydroxy chloroquine has shown variable results with frequent relapses. Because lesions on the lips are highly susceptible to actinic changes and malignant transformation, these patients require regular and long-term follow-up. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Giant myelolipoma; benign yet life-threatening! p. 292 Pranita Mohanty, Rupanita Biswal, Jhasaketan Nayak DOI:10.4103/JDRNTRUHS.JDRNTRUHS_16_18   Myelolipoma, an incidentaloma, is rarely encountered, especially in adrenal location. Huge myelolipomas are extremely rare and are of surgical emergency. Here we report a 33-year-old male who presented with pain in the right lumbar region with normal complete hemogram and serum hormonal markers. Ultrasonography and contrast-enhanced computed tomography abdomen revealed a huge well-defined homogeneous mass in the right adrenal region which was then removed surgically and histology revealed benign myelolipoma. Myelolipomas are benign and usually asymptomatic. But large lesions may have acute presentation and hence have to be dealt with utmost urgency along with proper imageological evaluation. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Ewing's sarcoma of calcaneum masquerading as chronic osteomyelitis: A case report p. 295 Siva K Prasad, K Meher Lakshmi, Venkateswara Rao Pydi, Shantveer G Uppin DOI:10.4103/JDRNTRUHS.JDRNTRUHS_14_18   Ewing's sarcoma is the second most common malignancy of bone among children. It commonly affects the diaphysial region of long bones, while small bones of hands and foot are rarely affected. We report a case of calcaneal Ewing's sarcoma which was misdiagnosed as fungal chronic osteomyelitis and treated inappropriately. High index of suspicion is required in diagnosing tumors at rare sites to avoid undue delay in initiating appropriate therapy. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Lesson learnt from a missed case of scrub typhus: An interesting case report p. 298 Murugaprakash Bagavathinathan, Prabha Thangaraj DOI:10.4103/JDRNTRUHS.JDRNTRUHS_78_18   The diagnosis of scrub typhus, though endemic in several parts of India, is missed due to various reasons such as nonspecific presentation of symptoms, lack of knowledge among treating physician, and poor access to diagnostic facilities. We present a case of scrub typhus in a 43-year-old woman whose clinical diagnosis was missed by two other physicians whom she approached before visiting us. A detailed history of social environment and general examination was sufficient to arrive at a diagnosis which was confirmed by the presence of IgM antibodies against scrub typhus. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Methicillin-resistant Staphylococcus aureus, Cytomegalovirus, and mucosal Candida albicans coinfection in a postrenal transplant recipient p. 301 Nupur Pal, Kalidas Rit, Munmun Sarkar DOI:10.4103/JDRNTRUHS.JDRNTRUHS_152_15   Here, we report a rare case of methicillin-resistant Staphylococcus aureus (MRSA), Cytomegalovirus (CMV), and mucosal Candida albicans coinfection in a post-renal transplant recipient. The patient presented with a cheek ulcer with nasal swelling after 2 months of immunosuppressive therapy following renal transplantation. Microbiological investigations revealed MRSA and C. albicans from the respective lesions and polymerase chain reaction for CMV from blood sample was positive. The patient was subsequently treated with appropriate regimen and is on regular follow-up. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Carbimazole-induced agranulocytosis – A rare case report p. 305 R Siddeswari, Sikandar Mohan, K Swamy DOI:10.4103/JDRNTRUHS.JDRNTRUHS_60_18   A 30-year-old lady with hyperthyroidism for the past 1 year was initially on carbimazole 30 mg twice orally and then changed to 30 mg once daily. She presented with intermittent fever since 3 weeks, h/o oral ulcers, difficulty in swallowing, and palpitations. Routine investigations showed anemia, neutropenia, leucopenia, and C-reactive protein elevation. Peripheral smear showed normocytic normochromic anemia with leucopenia. Widal test, RA factor test, immunoglobulin M (Ig M) dengue, Ig M Lepto, antinuclear antibody screen, cytoplasmic antineutrophil cytoplasmic antibodies, and perinuclear anti-neutrophil cytoplasmic antibodies tests were negative. Viral markers are negative. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Rheumatological manifestation of diabetes: "Namaste" sign p. 308 M Mahesh, N Jeswanth Reddy, S Mamatha, M Madhumitha DOI:10.4103/JDRNTRUHS.JDRNTRUHS_108_17   In addition to the well-known complications such as neuropathy, nephropathy, retinopathy, diabetes mellitus can also result in a variety of rheumatologic manifestations, some of which can significantly affect a patient's quality of life. Diabetic cheiroarthropathy (DCA), which affects the hands clinically, manifests as painless limited extension of the proximal metacarpophalangeal joints and/or interphalangeal joints with spontaneous flexion of the fingers. There is decreased ability to fully flex or fully extend the fingers. This is the so-called "Namaste" or "Prayer" sign. This sign gives an indication of metabolic control of diabetes and microvascular disease. We hereby report a middle-age male patient admitted for fever and was incidentally found positive for this sign. Fundoscopy revealed nonproliferative diabetic retinopathy and there was microalbuminuria. The diagnosis is mainly clinical. It is imperative for clinicians to remember that the presence of DCA carries with it a significant relationship with microvasculopathy. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Factors affecting the functioning of Rogi Kalyan Samitis in Uttarakhand state of India p. 311 Enakshi Ganguly DOI:10.4103/JDRNTRUHS.JDRNTRUHS_41_18   Introduction: The Rogi Kalyan Samitis (RKSs) in Uttarakhand were formed at community health centers (CHCs) to monitor and improve the quality of services offered. Methodology: An independent study was taken up to study the progress made by RKSs in two districts of the state. This article presents the different factors affecting the functioning of RKSs. Data were collected from all member secretaries and at least 20% sampled members in all RKSs in eight CHCs. Results: RKS is not functioning properly in both the districts because of a number of inhibitory factors such as poor interest of the members and lack of awareness among members and the general community. Conclusion: Educational activities about spreading awareness regarding the existence and activities of RKS should be undertaken in those areas where the RKS is not performing well. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Feedback Subscribe

Patient Safety and Infection Control

Clinical spectrum and resistance pattern of community-acquired invasive Staphylococcus aureus infection in children Mohd Kashif, Yusuf Imran Ansari, Tarique Ekram, Fatima Khan, Tabassum Nawab, Shaad Abqari Journal of Patient Safety and Infection Control 2018 6(2):33-37 Introduction: The incidence of Staphylococcal infections has been increasing over the last 20 years and MRSA infection is becoming an important cause of hospital infection among children. Aims and Objectives: The study aimed to delineate the clinical spectrum of Staphylococcus aureus infection in children, their complications, antimicrobial resistance patterns and response to treatment. Materials and Methods: Children with suspected community acquired invasive S. aureus infections were retrospectively identified. Fifty patients with proven S.aureus infection on culture from clinically relevant sites were included. Their symptoms, course of disease, complications, antimicrobial resistance pattern and response to treatment is described. Results and Conclusions: Out of a total of 50 cases, S.aureus isolates from 31 (62%) cases were sensitive to oxacillin while resistance to this antibiotic was reported in 19 (38%) cases. Most common site for localisation of infection was present in lungs (40%) followed by CNS (16%), skin (8%) and bone (4%) The focality of infection and pattern of resistance were not significantly associated with outcomes.

Patient safety and infection control in operation theatre: A prospective observational study in a tertiary care hospital of India Deepti Sahran, Vijaydeep Siddharth, Sidhartha Satpathy Journal of Patient Safety and Infection Control 2018 6(2):38-44 Introduction: This study aimed to observe the various patient care processes pertaining to patient safety including infection control. Materials and Methods: A descriptive, prospective, observational, qualitative study was conducted in operation theatre (OT) complex of a tertiary care teaching hospital of North India from January to December 2016. Eleven operating rooms utilised for performing routine surgeries were included in the study. Non-participant observations were made by the single trained observer, and in-depth unstructured discussions were also held with the key stakeholders. One OT each for a full day per week was observed. Simple random sampling without replacement using chit system was used for selecting the OT and day of the week for data collection. Results: There are documented infection control guidelines which are being utilised for infection control. There is no patient safety committee, no guidelines on patient safety and no mechanism has been established for reporting of the patient safety incidents. Implementation of surgical safety checklist was inadequate and only nursing personnel filled it. There is a comprehensive training programme available for infection control among nursing staff only but not on patient safety. Only one adverse event was observed during the study period, in addition to four near misses. Conclusion: Culture of patient safety needs to be established, especially in critical areas such as OT. Mechanism needs to be developed for capturing data pertaining to patient safety and patient safety practices, especially implementation of surgical safety checklist need intense and sustained efforts.

Prevalence of needle-stick injuries among health-care workers in a tertiary care centre in North India Sana Islahi, Vineeta Mittal, Manodeep Sen Journal of Patient Safety and Infection Control 2018 6(2):45-50 Background: Healthcare-associated infections among health-care workers (HCWs) commonly follow occupational exposures to pathogens through sharp, cuts and splashes contaminated with infected blood or body fluids of patients. The objective of this study was to determine the occurrence of self-reported occupational exposures to these hazards and to know the prevalent practices following the exposure. Materials and Methods: An observational prospective study was done in the HCWs of a tertiary care centre of North India from January 2015 to December 2016. At the time of self-reporting of injury, a questionnaire was administered. Blood sample of HCWs and of the source, if identified, was collected for baseline hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) serum markers. Follow-up status before and after needle-stick injuries (NSIs) was done. Results: NSIs were reduced from 18 (70.37%) in 2015 to 8 (29.62%) in 2016 with P < 0.05. The maximum numbers of NSIs were found in staff nurses (68.64%), mostly with hollow bore needle (68.75%), during insertion of intravenous cannula (29.66%). Maximum type of injury was superficial percutaneous (62.82%). 35.89% of the HCWs who had NSI were not immunised with HBV vaccines. Post-exposure prophylaxis for HIV was started within 2 h of exposures in whom it was warranted. Conclusions: The study indicates that supervised training, especially during initial stressful years, is needed not only to reduce the incidence of NSIs but also to improve work performance.

Profile of fatal geriatric trauma at a Level 1 trauma centre of India Sanjeev Lalwani, Purva Mathur, Mahesh Kumar, Chhavi Sawhney, Deepak Agrawal, Omika Katoch Journal of Patient Safety and Infection Control 2018 6(2):51-53 Background: Trauma in old age is a serious health issue and associated with high fatality. This study details the profile of fatal geriatric trauma at a Level 1 Indian trauma centre. Methods: This is a retrospective study. A total of 779 geriatric patients were admitted to the Jai Prakash Narayan Apex Trauma Centre during 2-year period from January 2014 to December 2015. A retrospective analysis was done of all 194 fatal geriatric trauma patients who underwent autopsy at our centre during this 2-year period. The study has been taken ethical clearance from the institutional review board. Setting: This study was conducted in a 165-bedded Level 1 trauma centre of India. Participants: Hundred and ninety-four fatal geriatric trauma patients were included in the study. Interventions: There were no interventions in this study. Measurements: Data were represented in median (range: minimum–maximum) and frequency (%). Results: The duration of admission of these 194 patients ranged from <1 to 91 days (median 3 days). The causes of trauma were road traffic accidents in 78 (40%), fall from height in 75 (39%), assault in 12 (6%), railway accident in 10 (5%) and unconsciousness in 10 (5%). The autopsy-proven primary cause of death was severe head injury in 89 (46%), septicaemia in 30 (15%), polytrauma in 11 (6%), orthotrauma in 12 (6%), haemorrhagic shock in 9 (5%), spinal injury in 8 (4%), musculoskeletal injury in 3 (2%) and fat embolism in 3 (2%). Conclusion: In our study, while most of the early deaths were due to severe head injuries, late deaths were predominantly due to infections.

Phenotypic and molecular characterization of extended spectrum beta lactamase and AmpC beta lactamases in Escherichia coli from a tertiary care centre in India Aishwarya Govindaswamy, Vijeta Bajpai, Priyam Batra, Rajesh Malhotra, Purva Mathur Journal of Patient Safety and Infection Control 2018 6(2):54-58 Background: Antibiotic resistance mediated by extended spectrum beta lactamase (ESBL) and AmpC enzymes in Escherichia coli continue to be a major threat in a health care setting. This study was undertaken to calculate the prevalence and to characterize ESBL and AmpC enzymes produced by E. coli by various phenotypic and molecular methods (polymerase chain reaction [PCR]). Materials and Methods: A total of 196 clinical isolates of E. coli were screened for ESBL production using cephalosporin disk diffusion method, minimum inhibitory concentration (MIC) determination by E-test and Vitek-2 system. Phenotypic confirmation for ESBL production was done using cephalosporin/clavulanate combination disc test method and E-test for ESBLs. For the detection of AmpC enzymes, cefoxitin disk diffusion and cefoxitin MIC testing was used and further phenotypically confirmed by three dimensional extract test, AmpC disk test, boronic acid disk test method and disk approximation method. The genotypic detection of ESBL genes and AmpC genes were done by PCR. Statistical Analysis: The data was analyzed using SPSS software (Version 21.0). Chi-square test was used for statistical analysis of the data. Results: The prevalence of ESBL and AmpC enzymes among E. coli isolates was found 93.12% and 28.68%. Among the various phenotypic screening methods evaluated, ceftazidime (CZD) disk diffusion test had the highest sensitivity of 90.67% and positive predict value of 92.86% followed by cefotaxime and CZD in comparison with polymerase chain reaction (PCR). For AmpC β-lactamases, the cefoxitin disk used for screening of AmpC β-lactamases had sensitivity of 91.67%, specificity of 59.14%, positive predict value of 46.48%, and negative predict value of 94.83% when compared with PCR. Conclusion: The high prevalence of ESBL and AmpC in our study emphasises on the judicious use of antibiotics in controlling antimicrobial resistance in the hospital.

Clinical experience of using chlorhexidine gluconate-impregnated dressings in reducing the central line-associated bloodstream infection rate at a Level 1 trauma centre Priyam Batra, S Thomas, Jacinta Gunjyal, Purva Mathur, Babita Gupta, Chhavi Swahnney, Deepak Agarwal, Ashish Bindra, Keshav Goyal, Richa Aggarwal, Kapil Soni, Rajesh Malhotra Journal of Patient Safety and Infection Control 2018 6(2):59-62 Introduction: Central venous catheters are vital in critical care which can be associated with infectious and non-infectious adverse events. Materials and Methods: This case–control study was conducted over 1 year in trauma centre of India. All patients admitted in intensive care units (ICUs) having central line inserted during the study period (November 2013–October 2014) were included as cases. Historical controls with non-antibiotic-impregnated dressings were used as controls (November 2012–October 2013). Standard central line insertion and maintenance checklist was followed. Results: A total of 2034 patients were admitted in ICUs during study period, and the central line-associated bloodstream infection (CLABSI) rate was 2.89/1000 catheter days. During the year 2012–2013, 2100 patients were admitted and CLABSI rate was 3.04/1000 catheter days. The mean central line insertion bundle compliance rate was 76.8% in 2012–2013 and 78.37% in 2013–2014. The compliance with scrubbing the access port was minimum 34% while that with change in dressing was the maximum 79%. Discussion: Since CLABSI rate reduction was not statistically significant, the use of biopatch in our setting could not be justified and its use was not found to be cost-effective. In maintenance bundle, compliance with scrubbing the hub was least only 35%. Thus, the use of effective maintenance bundle parameters could easily reduce CLABSI rate.

Prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus and their implication in occupational health Areena Hoda Siddiqui, Vipul Kumar Srivastava Journal of Patient Safety and Infection Control 2018 6(2):63-65 ORIGINAL ARTICLES   Clinical spectrum and resistance pattern of community-acquired invasive Staphylococcus aureus infection in children p. 33 Mohd Kashif, Yusuf Imran Ansari, Tarique Ekram, Fatima Khan, Tabassum Nawab, Shaad Abqari DOI:10.4103/jpsic.jpsic_12_18   Introduction: The incidence of Staphylococcal infections has been increasing over the last 20 years and MRSA infection is becoming an important cause of hospital infection among children. Aims and Objectives: The study aimed to delineate the clinical spectrum of Staphylococcus aureus infection in children, their complications, antimicrobial resistance patterns and response to treatment. Materials and Methods: Children with suspected community acquired invasive S. aureus infections were retrospectively identified. Fifty patients with proven S.aureus infection on culture from clinically relevant sites were included. Their symptoms, course of disease, complications, antimicrobial resistance pattern and response to treatment is described. Results and Conclusions: Out of a total of 50 cases, S.aureus isolates from 31 (62%) cases were sensitive to oxacillin while resistance to this antibiotic was reported in 19 (38%) cases. Most common site for localisation of infection was present in lungs (40%) followed by CNS (16%), skin (8%) and bone (4%) The focality of infection and pattern of resistance were not significantly associated with outcomes. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Patient safety and infection control in operation theatre: A prospective observational study in a tertiary care hospital of India p. 38 Deepti Sahran, Vijaydeep Siddharth, Sidhartha Satpathy DOI:10.4103/jpsic.jpsic_14_18   Introduction: This study aimed to observe the various patient care processes pertaining to patient safety including infection control. Materials and Methods: A descriptive, prospective, observational, qualitative study was conducted in operation theatre (OT) complex of a tertiary care teaching hospital of North India from January to December 2016. Eleven operating rooms utilised for performing routine surgeries were included in the study. Non-participant observations were made by the single trained observer, and in-depth unstructured discussions were also held with the key stakeholders. One OT each for a full day per week was observed. Simple random sampling without replacement using chit system was used for selecting the OT and day of the week for data collection. Results: There are documented infection control guidelines which are being utilised for infection control. There is no patient safety committee, no guidelines on patient safety and no mechanism has been established for reporting of the patient safety incidents. Implementation of surgical safety checklist was inadequate and only nursing personnel filled it. There is a comprehensive training programme available for infection control among nursing staff only but not on patient safety. Only one adverse event was observed during the study period, in addition to four near misses. Conclusion: Culture of patient safety needs to be established, especially in critical areas such as OT. Mechanism needs to be developed for capturing data pertaining to patient safety and patient safety practices, especially implementation of surgical safety checklist need intense and sustained efforts. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Prevalence of needle-stick injuries among health-care workers in a tertiary care centre in North India p. 45 Sana Islahi, Vineeta Mittal, Manodeep Sen DOI:10.4103/jpsic.jpsic_13_18   Background: Healthcare-associated infections among health-care workers (HCWs) commonly follow occupational exposures to pathogens through sharp, cuts and splashes contaminated with infected blood or body fluids of patients. The objective of this study was to determine the occurrence of self-reported occupational exposures to these hazards and to know the prevalent practices following the exposure. Materials and Methods: An observational prospective study was done in the HCWs of a tertiary care centre of North India from January 2015 to December 2016. At the time of self-reporting of injury, a questionnaire was administered. Blood sample of HCWs and of the source, if identified, was collected for baseline hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) serum markers. Follow-up status before and after needle-stick injuries (NSIs) was done. Results: NSIs were reduced from 18 (70.37%) in 2015 to 8 (29.62%) in 2016 with P < 0.05. The maximum numbers of NSIs were found in staff nurses (68.64%), mostly with hollow bore needle (68.75%), during insertion of intravenous cannula (29.66%). Maximum type of injury was superficial percutaneous (62.82%). 35.89% of the HCWs who had NSI were not immunised with HBV vaccines. Post-exposure prophylaxis for HIV was started within 2 h of exposures in whom it was warranted. Conclusions: The study indicates that supervised training, especially during initial stressful years, is needed not only to reduce the incidence of NSIs but also to improve work performance. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Profile of fatal geriatric trauma at a Level 1 trauma centre of India p. 51 Sanjeev Lalwani, Purva Mathur, Mahesh Kumar, Chhavi Sawhney, Deepak Agrawal, Omika Katoch DOI:10.4103/jpsic.jpsic_8_18   Background: Trauma in old age is a serious health issue and associated with high fatality. This study details the profile of fatal geriatric trauma at a Level 1 Indian trauma centre. Methods: This is a retrospective study. A total of 779 geriatric patients were admitted to the Jai Prakash Narayan Apex Trauma Centre during 2-year period from January 2014 to December 2015. A retrospective analysis was done of all 194 fatal geriatric trauma patients who underwent autopsy at our centre during this 2-year period. The study has been taken ethical clearance from the institutional review board. Setting: This study was conducted in a 165-bedded Level 1 trauma centre of India. Participants: Hundred and ninety-four fatal geriatric trauma patients were included in the study. Interventions: There were no interventions in this study. Measurements: Data were represented in median (range: minimum–maximum) and frequency (%). Results: The duration of admission of these 194 patients ranged from <1 to 91 days (median 3 days). The causes of trauma were road traffic accidents in 78 (40%), fall from height in 75 (39%), assault in 12 (6%), railway accident in 10 (5%) and unconsciousness in 10 (5%). The autopsy-proven primary cause of death was severe head injury in 89 (46%), septicaemia in 30 (15%), polytrauma in 11 (6%), orthotrauma in 12 (6%), haemorrhagic shock in 9 (5%), spinal injury in 8 (4%), musculoskeletal injury in 3 (2%) and fat embolism in 3 (2%). Conclusion: In our study, while most of the early deaths were due to severe head injuries, late deaths were predominantly due to infections. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Phenotypic and molecular characterization of extended spectrum beta lactamase and AmpC beta lactamases in Escherichia coli from a tertiary care centre in India p. 54 Aishwarya Govindaswamy, Vijeta Bajpai, Priyam Batra, Rajesh Malhotra, Purva Mathur DOI:10.4103/jpsic.jpsic_11_18   Background: Antibiotic resistance mediated by extended spectrum beta lactamase (ESBL) and AmpC enzymes in Escherichia coli continue to be a major threat in a health care setting. This study was undertaken to calculate the prevalence and to characterize ESBL and AmpC enzymes produced by E. coli by various phenotypic and molecular methods (polymerase chain reaction [PCR]). Materials and Methods: A total of 196 clinical isolates of E. coli were screened for ESBL production using cephalosporin disk diffusion method, minimum inhibitory concentration (MIC) determination by E-test and Vitek-2 system. Phenotypic confirmation for ESBL production was done using cephalosporin/clavulanate combination disc test method and E-test for ESBLs. For the detection of AmpC enzymes, cefoxitin disk diffusion and cefoxitin MIC testing was used and further phenotypically confirmed by three dimensional extract test, AmpC disk test, boronic acid disk test method and disk approximation method. The genotypic detection of ESBL genes and AmpC genes were done by PCR. Statistical Analysis: The data was analyzed using SPSS software (Version 21.0). Chi-square test was used for statistical analysis of the data. Results: The prevalence of ESBL and AmpC enzymes among E. coli isolates was found 93.12% and 28.68%. Among the various phenotypic screening methods evaluated, ceftazidime (CZD) disk diffusion test had the highest sensitivity of 90.67% and positive predict value of 92.86% followed by cefotaxime and CZD in comparison with polymerase chain reaction (PCR). For AmpC β-lactamases, the cefoxitin disk used for screening of AmpC β-lactamases had sensitivity of 91.67%, specificity of 59.14%, positive predict value of 46.48%, and negative predict value of 94.83% when compared with PCR. Conclusion: The high prevalence of ESBL and AmpC in our study emphasises on the judicious use of antibiotics in controlling antimicrobial resistance in the hospital. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Clinical experience of using chlorhexidine gluconate-impregnated dressings in reducing the central line-associated bloodstream infection rate at a Level 1 trauma centre p. 59 Priyam Batra, S Thomas, Jacinta Gunjyal, Purva Mathur, Babita Gupta, Chhavi Swahnney, Deepak Agarwal, Ashish Bindra, Keshav Goyal, Richa Aggarwal, Kapil Soni, Rajesh Malhotra DOI:10.4103/jpsic.jpsic_15_18   Introduction: Central venous catheters are vital in critical care which can be associated with infectious and non-infectious adverse events. Materials and Methods: This case–control study was conducted over 1 year in trauma centre of India. All patients admitted in intensive care units (ICUs) having central line inserted during the study period (November 2013–October 2014) were included as cases. Historical controls with non-antibiotic-impregnated dressings were used as controls (November 2012–October 2013). Standard central line insertion and maintenance checklist was followed. Results: A total of 2034 patients were admitted in ICUs during study period, and the central line-associated bloodstream infection (CLABSI) rate was 2.89/1000 catheter days. During the year 2012–2013, 2100 patients were admitted and CLABSI rate was 3.04/1000 catheter days. The mean central line insertion bundle compliance rate was 76.8% in 2012–2013 and 78.37% in 2013–2014. The compliance with scrubbing the access port was minimum 34% while that with change in dressing was the maximum 79%. Discussion: Since CLABSI rate reduction was not statistically significant, the use of biopatch in our setting could not be justified and its use was not found to be cost-effective. In maintenance bundle, compliance with scrubbing the hub was least only 35%. Thus, the use of effective maintenance bundle parameters could easily reduce CLABSI rate. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta PERSPECTIVE Prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus and their implication in occupational health p. 63 Areena Hoda Siddiqui, Vipul Kumar Srivastava DOI:10.4103/jpsic.jpsic_1_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta