Exploring Patterns of Palmar Hyperlinearity in Pediatric Population With Atopic Dermatitis or Ichthyosis Vulgaris Attending a Tertiary Care Hospital in Jaipur, India

Background: Over the last few years, an unexpected increase in the prevalence of diabetes in India have been witnessed. The present study was planned to analyse prescribing patterns of anti-hyperglycaemic drugs and assess the influence of Chief Minister's Free Drug Scheme in Rajasthan, India. It aimed to evaluate, monitor and if possible, suggest modifications in prescribing practices to make medical care rational and also to assist minimising adverse drug reactions (ADRs). Methods: This was a cross-sectional, observational study carried out for a 12-month period. A total 400 known patients of type 2 diabetes mellitus (T2DM) from endocrinology outdoor of SMS Medical College Hospital (a tertiary care hospital in Jaipur, Rajasthan, India) were recruited and their prescriptions were analysed using the World Health Organization (WHO) prescribing indicators. Results: Most commonly observed age group was of 40-50 years (mean age 53.76 ± 8.84), with a male preponderance (57.5 %). Among them, 67.5 % of patients were found to be obese (mean BMI 29.79 ± 3.26). All anti-hyperglycaemic were prescribed in their generic names only. Metformin was the most frequently prescribed anti-hyperglycaemic agent. Among the fixed dose combinations, the most common was that of glimepiride and metformin (40.75 %), while most prescribed add on anti-hyperglycaemic was teneligliptin (51.5 %), followed by pioglitazone (30.5 %). A total of 53.25 % of these patients received insulin along with oral anti-hyperglycaemic agents. Conclusion: The anti-hyperglycaemic agent prescribing among endocrinology outpatients at tertiary care hospital in Jaipur was found to be satisfactory.

BackgroundWorld is in grip of coronavirus disease-2019 (COVID-19) pandemic right now. Majority of studies center around its epidemiological and clinical characteristics. Information regarding secondary bacterial infections is limited. This retrospective observational study was done to determine the prevalence and characteristics of bloodstream infections in COVID-19 patients admitted in a tertiary care center in Jaipur.Materials and methodsAll blood cultures received from COVID-19 positive patients admitted in designated COVID care ICUs and wards were included in the study. A predesigned pretested questionnaire was used to collect relevant data. Blood cultures were done using BD BACTEC™ FX40, and identification and antimicrobial susceptibility testing of isolates were done by VITEK® 2 COMPACT.ResultsOne thousand five hundred seventy-eight (1578) COVID-19 positive patients were admitted in center during 5-month study period from whom 158 blood cultures were received. Out of these, 15 (9.4%) were positive. Median age of patients with positive blood culture was 54 years and included 10 males and 5 females. Ten (67%) patients needed intensive care in ICU. Significant correlation of blood culture positivity was found with parameters like ICU admission, presence of an indwelling device, underlying comorbidity, raised biochemical markers, and adverse clinical outcome.ConclusionsIncidence of bloodstream infections is low for COVID-19 patients. Antibiotic prophylaxis needs to be used with caution, and prompt discontinuation should be done based on clinical judgment.How to cite this articleRajni E, Garg VK, Bacchani D, Sharma R, Vohra R, Mamoria V, et al. Prevalence of Bloodstream Infections and their Etiology in COVID-19 Patients Admitted in a Tertiary Care Hospital in Jaipur. Indian J Crit Care Med 2021;25(4):369–373.

Medical healthcare providers are an important link with the general public to impart knowledge regarding contraception. However, their own attitude and practice of contraception is often lacking. Objective This study was conducted to assess the attitude and practice of contraception over the last 5 years of the gynecologists themselves in a tertiary care hospital in Jaipur. Materials and methods The study was conducted on 125 female gynecologists in a tertiary care hospital in Jaipur. All were given a questionnaire which was duly filled by them and data obtained was analyzed. Results All the doctors used some form of contraception. The mean age was 29.32 years. The commonest was the barrier method (38.4%) followed by OC pills (27.2%). Twenty-one percent of the barrier users used them occasionally. Emergency contraception was used by either those using natural methods of contraception or who were occasional users of OC pills or condoms. Fifty percent of the couples relying on natural methods conceived. Conclusion Gynecologists have complete knowledge regarding contraception, yet fail to use it regularly. Proper attitude and practice is essential to prevent unintended pregnancies. How to cite this article Hemani S, Hooja N, Mital P. Attitude and Practice of Contraception among Gynecologists at a Tertiary Care Hospital. J South Asian Feder Obst Gynae 2013;5(3): 129-131.

Candida auris is identified as an emerging pathogen worldwide. It is multidrug resistant and causes invasive healthcare-associated infections. Our retrospective study was conducted to determine the prevalence and epidemiology of C. auris infections in a tertiary care hospital in Jaipur. 24 clinical C. auris strains were included, most being from urine. The majority patients needed intensive care and had at least one underlying co-morbid condition. A history of broad-spectrum antibiotic or antifungal usage was present in 85%. Fluconazole, voriconazole, amphotericin B and 5-fluorocytosine resistance was seen in 96, 42, 33 and 8% isolates respectively. No echinocandin resistance was noted.

Introduction: Diabetes mellitus refers to a group of common metabolic disorders. Recently, emerging evidence has suggested a role for suboptimal vitamin D status in the etiology of T2DM. This study aimed to determine the association between Vitamin -D deficiency and type 2 Diabetes Mellitus in patients of tertiary care centre, Jaipur. Method and material: This was a hospital based descriptive type of observational study done in Department of Medicine, of a tertiary care hospital in Jaipur, Rajasthan. This study included 100 cases and 100 control. Result: There were 55% males and 45% female among study participants. Out of 200 participants, 160 (80%) subjects are vit D deficient in which 84 (42%) are cases and 76 (38%) are controls, means cases are more deficient for vit D in comparision to controls. Conclusion: Though vitamin D deficiency is prevalent in T2DM and non-diabetic control subjects, its relationship in glycation control or insulin resistance in T2DM subjects could not be confirmed in our study population. This is potentially an important finding for public health, demonstrating that improvement in vitamin D status is one of the factors responsible for better health of the individuals.

Background: COVID-19 is a pandemic disorder spreading rapidly worldwide. Most of the countries were affected by the COVID-19 during the year 2020. Demographic data are important to understand the impact of COVID-19 across the country and also provide information on an appropriate response, planning, and allocation of resources. This study aims to assess the demographic data of COVID-19 patients admitted and treated in a tertiary care hospital, Jaipur. Materials and Methods: This is a retrospective study conducted in a tertiary care hospital in Jaipur. A total of 1149 patients’ data like age, gender, area they belong to, duration of the treatment, etc., were collected from the medical records department (MRD) department between July 1, 2020 and September 30, 2020. The data were expressed as counts, number, and percentage (%). The data were analyzed using Excel software. Results: Out of 1149 patients, 70% were males and 30% were females, respectively, and mean ± SD (standard deviation) of age was 44.23 ± 3.57. Most of the cases were obtained from Jaipur 63%, Bikaner 5.4%, Ajmer 4.4%, Alwar 2.6%, Sawai Madhopur 2.6%, Dausa 2.3%, Nagaur 2.3%, Bharatpur 2.1%, and Karauli 1.7%, respectively, and remaining places reported <1.5% cases. Also 40 to 80 years age groups were most affected. About 32.4% mild, 55.7% moderate, and 11.8% severe cases were reported. Conclusions: More male patients were affected when compared with female patients. Age and other disease conditions have a positive correlation with COVID-19. Older people should take extra precautions and avoid going to markets, parties, etc., unless it is essential. Early identification and detection of COVID-19 helps in better treatment and preventing the conversion of mild cases into moderate or severe cases and prevents the transmission from one to another.

Introduction: Autoimmunity is the immune response of antibodies against normal cellular components. With the advent of serological testing for autoimmune disorders, detection of anti-nuclear antibodies (ANA) by indirect immunofluorescence method became the gold standard. ANA screening is non-specific, reliable and a quick way and identifies immunofluorescent patterns linked to autoimmune disorders. Aim: This study was undertaken to identify the prevalence of ANA patterns amongst the various demo graph presented in a tertiary care hospital in Jaipur, Rajasthan. Material and Method: 100 serum samples were screened by indirect immunofluorescence microscopy in the duration of July 2021 to October 2021. Results: 27% of the serum samples presented with positive ANA patterns out of which 62.96% were nuclear speckled, followed by 22.22% of nuclear homogenous pattern and 7.40% were observed to be cytoplasmic speckled. The age bracket with higher positivity were 20-40 years (28%) and 40-60 (28%). There was female predominance noted in the ANA positivity. Conclusion: Nuclear speckled was the most frequent pattern, few unusual patterns were also observed. An observational study is needed to understand not only the epidemiology of autoimmune disorders but also the predictive value of ANA IIF in clinical setup, besides considering the possibility of taking up IIF as a screening tool for autoimmune disorders. Keywords: Antinuclear antibody (ANA), indirect immunofluorescence (IIF), systemic lupus erythematosus (SLE), autoantibody.

IntroductionIntracranial tumourstumors arise from the brain or its surrounding tissues. Tumors of the central nervous system (CNS) are estimated to be approximately 2% of all new cancers. In India, they constitute about 1.9% of all tumors. Extramedullary lesions, most commonly benign meningioma, account for 70 to 80% of spinal cord tumors. The objective of this study is to characterize histological subtypes, age and gender distribution, and WHO grading of intracranial and spinal tumors in a tertiary care hospital in Jaipur, Rajasthan, India.Material and methodA retrospective study was conducted at the Department of Surgical Oncology, Sawai Man Singh (SMS) hospital, Jaipur, Rajasthan, a tertiary care hospital, over a period of 5 years. A total of 1315 cases of CNS and spinal neoplasms were diagnosed during this period.Results In this study, a total of 1315 cases of CNS and spinal tumors were found. The majority (1199 cases, 91.2%) of the tumors were intracranial, whereas the remaining 116 (8.82%) cases were spinal. Among intracranial tumors, astrocytomas accounted for the largest share in our study, comprising 398 cases (30.27%), mostly seen after the 3rd decade of life, with a mean age of occurrence of 28.44 years. Glioblastoma multiforme forms the largest subtype, constituting 41.96% of all astrocytoma, mostly seen in the 5th or 6th decade of life. Meningioma constitutes the second major group of tumors involving the CNS. Overall, males outnumbered females, the ratio being 1.66:1. However, meningioma is an exception, which was found with higher rates in females (ratio 1:1.37). Among the spinal neoplasms, meningioma was the most common type in our study.ConclusionThe most common type of intracranial tumor in the present study was astrocytoma, followed by meningioma. The ratio of male: female for CNS tumors was 1.66:1. However, females outnumbered males in the case of meningioma, with a ratio of 1:1.37. Meningioma was the most common type of spinal neoplasm.

Antimicrobial resistance (AMR) is a growing global health problem. Staphylococcus aureus is a commonest bacterium associated with community acquired and nosocomial infections. Methicillin resistant strains are increasingly being reported worldwide. In this study, we determined the prevalence and antimicrobial susceptibility pattern of Methicillin resistant Staphylococcus aureus (MRSA), isolated from various clinical specimens from a tertiary care hospital. The study comprised of 545 strains of Staphylococcus aureus isolated from various clinical specimens using standard microbiological procedures. From these isolates, methicillin resistant strains were screened, and their antimicrobial susceptibility pattern was detected according to CLSI 2020 guidelines. Out of 545 strains a total of 358 Strains were found to be methicillin resistant. In this study all MRSA strains were Vancomycin sensitive and majority of the MRSA strains were linezolid susceptible. However, Vancomycin intermediate and Linezolid resistant strains has been reported in some studies, but not found in our study.

As death is final outcome of life, it is inevitable in prisoners too. Pattern of deaths can reveal living conditions and practices in a population. This study was conducted to observe the pattern of natural deaths among prisoners autopsied at a tertiary care hospital in Jaipur during April 2017 to March 2018. During this period 16 cases of alleged natural deaths in custody were autopsied comprising of 15 males and 1 female. The natural deaths were almost evenly distributed in all age groups. Carcinoma was leading cause of death in (37.5%) cases, followed by cardio-vascular causes in (25%) cases, intracranial hemorrhage in (12.5%) cases, septicaemia in (12.5%) cases, tuberculosis associated with HIV in (6.25%) case and Pneumonia associated with Parkinsonism in (6.25%) cases. All (100%) of the natural deaths received medical attention prior to death and died in hospital. Injuries were present in 5 cases (31.25%) but were not attributed to causing deaths.

Background and Aims: Dengue is one of the most severe mosquito-borne viral infection. In the absence of specific treatments and vaccines for dengue fever (DF), vector control is the only method by which the spread of dengue can be prevented. This study investigates the seroprevalence of DF cases by detecting NS1 antigen and immunoglobulin (Ig)-G and IgM antibody by enzyme-linked immunosorbent assay (ELISA) test. Materials and Methods: This study was carried out in the Department of Microbiology, at a Tertiary Care Hospital, Jaipur (Rajasthan), done between 6 months. Blood samples from clinically suspected cases of dengue were tested immediately for qualitative detection of NS1 Ag, IgM, and IgG antibodies by ELISA. Results: One thousand seven hundred and sixty-three serum samples were tested for dengue NS1 antigen, IgM, and IgG, out of which 1066 were positive for one or more serological parameters. Dengue cases for the NS1 infection are 52.53%, for the IgM infection is 33.39%, and for the IgG infection is 14.07%. Sixty-two percentage positive samples were of male patients and 57% of positive samples were from 19 to 40 years of age group (adult population) (59%). The seasonal trend showed a gradual increase in dengue-positive cases that started in September with a peak in October (46.24%). Conclusion: The monsoon and postmonsoon seasons are times of high virus activity and enhanced vector breeding. The population must thus be constantly monitored to prevent the virus from spreading further, and serological tests are crucial for making an early diagnosis. ELISA is advised for all suspected dengue patients to initiate therapy and decrease the morbidity and fatality rate.

Prevalence of fungal isolates in various respiratory samples at tertiary care hospital in Jaipur, Rajasthan

Background:Urinary tract infections (UTIs) are amongst the most common infections described in outpatients setting.Objectives:A study was conducted to evaluate the uropathogenic bacterial flora and its antimicrobial susceptibility profile among patients presenting to the out-patient clinics of a tertiary care hospital at Jaipur, Rajasthan.Materials and Methods:2012 consecutive urine specimens from symptomatic UTI cases attending to the outpatient clinics were processed in the Microbiology lab. Bacterial isolates obtained were identified using biochemical reactions. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method. Extended spectrum beta lactamase (ESBL) production was determined by the double disk approximation test and the Clinical and Laboratory Standards Institute (formerly NCCLS) confirmatory method.Results:Pathogens were isolated from 346 (17.16%) of the 2012 patients who submitted a urine sample. Escherichia coli was the most frequently isolated community acquired uropathogen accounting for 61.84% of the total isolates. ESBL production was observed in 23.83% of E. coli strains and 8.69% of Klebsiella strains. With the exception of Nitrofurantoin, resistance to agents commonly used as empiric oral treatments for UTI was quite high.Conclusion:The study revealed E. coli as the predominant bacterial pathogen for the community acquired UTIs in Jaipur, Rajasthan. An increasing trend in the production ESBLs among UTI pathogens in the community was noted. Nitrofurantoin should be used as empirical therapy for primary, uncomplicated UTIs.

Background and Aim: Ventilator-associated pneumonia (VAP) is considered as a sub-category of healthcare-associated infections and is associated with high morbidity and mortality. Acinetobacter baumannii complex and Klebsiella pneumoniae (K. pneumoniae) are known to be the most important causes. During the last few decades, polymyxins have represented the most commonly used antimicrobial options against multidrug resistant K. pneumoniae. However, in some cases, aminoglycosides were also found to be effective. Materials and Methods: This retrospective observational study was conducted in a tertiary care hospital in Jaipur from June' 2020 to June' 2021. All endotracheal (ET) aspirate samples from the clinically suspected cases of VAP received in microbiology laboratory were processed using the standard procedures and relevant medical records were reviewed. VITEK 2 automated system was used for the bacterial identification and antimicrobial susceptibility testing. Results: Out of 705 ET aspirate samples received during the study period, 467 were found culture positive. Majority 304 (98.1%) were Gram-negative isolates, while only 6 (1.9%) were Gram-positive. 156;51.3% isolates belonged to A. baumannii complex, followed by K. pneumoniae (73;24.0%). Antimicrobial susceptibility profile of 73 K. pneumoniae isolates to aminoglycosides was noted. Out of 73 isolates, 42 were found to be resistant to both gentamicin and amikacin, 12 isolates were sensitive to both, while 19 isolates showed variable susceptibility. Conclusion: K. pneumoniae is an important causative agent of VAP. While polymyxins have an important role in the management of such cases, aminoglycosides need to be given a careful consideration. They can constitute an effective polymyxin sparing regimen, especially for carbapenem-resistant isolates.

Chronic obstructive pulmonary disease (COPD) is a common disease causing significant socioeconomic burden. COPD patients, commonly smokers develop resistance to inhaled steroids attributed to deficiency of histone deacetylase 2 (HDAC2). The study of relationship between systemic inflammation and functional performance demonstrated that increased CRP level is inversely related to six minute walk distance (SMWD) and Forced Expired Volume in one second (FEV1). Theophylline restores HDAC2 activity thereby unlocking steroid resistance and potentiating inhaled corticosteroids (ICS) action culminating in reduced airway inflammation and mortality. To study the effects of addition of Theophylline to the combination of Formoterol plus Budesonide on various objective and subjective parameters in moderate to severe COPD patients and to assess the safety profile of the combination. Setting and Study design: A single blinded, prospective, randomized, placebo controlled study at a tertiary care hospital in Jaipur, India. Fifty eight patients diagnosed with moderate to severe COPD were randomized into two groups. Group A patients received Formoterol 24μg plus budesonide 800μg daily in divided doses along with Theophylline while group B patients received Formoterol 24μg plus budesonide 800μg daily in divided doses along with placebo tablets. Both groups were followed up on 15th, 30th &60th day. During every visit all patients were assessed subjectively (symptom scoring) and objectively (spirometry, CRP, SMWT) and adverse effects if any were recorded. The obtained data subject to statistical analysis using"Graph pad Instat3" software. Statistically significant improvement with a decline in total symptom score (p < 0.0001) was found with respect to "Night symptoms"&"SOB on rising" in group A. Theophylline group showed significant improvement in SMWD and FEV1.Mean fall in CRP was greater in Group A (not statistically significant). No side effects requiring withdrawal of drug were noted with Theophylline. Addition of Theophylline to Formoterol plus Budesonide reduces dyspnea, improves exercise performance and pulmonary functions in moderate to severe COPD. Further studies are required to explore if reduced dosage would have equal efficacy with better safety and tolerability profile.