Histopathological Spectrum of Endoscopic Lower Gastrointestinal Tract Biopsies: A Cross-sectional Study in a Tertiary Care Hospital in Mumbai, Maharashtra, India

Background: Infant feeding practices have a major role in determining the nutritional status of a child. Despite several benefits of exclusive breastfeeding, the practice is not common in many developing nations, including India. So there is a need to assess factors associated with exclusive breast feeding by mothers.Methods: A cross sectional study using the quantitative method by the means of a well prepared questionnaire, carried out in the pediatric ward of a tertiary care hospital in Mumbai. Data was collected by face to face interview and filed in a pretested, semi-structured, questionnaire. Data entry was done in excel sheet and analysed with the help of epi-info and statistical package for the social sciences (SPSS) software and was presented in tabular and graphical form.Results: A total of 112 mothers with infants <6 months of age participated in the study with a response rate of 98%.Conclusions: Majority of mothers’ perception about exclusive breastfeeding was that they considered it insufficient for their infant’s health and nutrition, and hence also relied on other feeds.

Predominance of Multidrug-Resistant Gram-Negative Organisms as Cause of Surgical Site Infections at a Private Tertiary Care Hospital in Mumbai, India

Background Pneumonia is a leading cause of morbidity and mortality in children under five years, especially in developing countries. Although the risk factors for childhood pneumonia are well documented, the relative contribution of these factors to disease severity remains less explored in Indian settings. This study evaluates the association between known epidemiological and modifiable risk factors and the clinical severity of pneumonia among hospitalized children aged 2–59 months. Assessment of these risk factors may lead to appropriate interventions resulting in reduction of severe disease and deaths. Methods A prospective cross-sectional study was conducted over 18 months in the pediatric ward and ICU of a tertiary care hospital in Mumbai after obtaining Ethics committee approval & parental consent. A total of 120 children aged 2 months–5 years with WHO-defined pneumonia were enrolled. Children were grouped into those with non-severe, severe, and very severe pneumonia. Risk factors assessed included parental education, breastfeeding, immunization, malnutrition, delayed healthcare-seeking and prior antibiotic use. Results Of 120 cases, 41 (34.2%) had non-severe, 59 (49.2%) severe, and 20 (16.7%) very severe pneumonia. Significant associations with pneumonia severity were found for low paternal education ( p < 0.001), short duration of exclusive breastfeeding ( p < 0.001), incomplete immunization ( p < 0.001), delayed healthcare-seeking ( p = 0.008), malnutrition ( p = 0.004), and prior antibiotic use ( p = 0.002). Maternal education and family history of recent respiratory infection were not significantly associated with pneumonia severity. Conclusion The following modifiable risk factors are associated with severe pneumonia: poor nutrition, incomplete immunization, delayed healthcare-seeking and prior antibiotic use. Interventions addressing these risks factors can substantially reduce childhood pneumonia morbidity and mortality.

Introduction The growing resistance pattern of the gram-positive pathogens along with a steady increase in minimum inhibitory concentration of the currently available antibiotics have led to an increase in morbidity and mortality rates in India. This study aims to access the shifting antibiotic susceptibility paradigm of the gram-positive pathogens in various infections at a tertiary care center. Methods This is a 3-year retrospective observational study which was performed from January 2016 to December 2018 at a tertiary care hospital in Mumbai. All clinically significant gram-positive cocci isolated from a variety of clinical specimens were studied for their prevalence and antimicrobial susceptibility. Results Out of 4,428 gram-positive isolates, Staphylococcus aureus (35.3%) was the commonly encountered pathogen, followed by Enterococcus spp. (32.1%) and coagulase-negative Staphylococcus (CoNS) (25.7%). S. aureus was majorly isolated from skin and soft tissue infections (60.3%), followed by patients with respiratory tract infections (18.2%) and blood stream infections (13%). Among S. aureus , particularly methicillin-resistant S. aureus (MRSA), prevalence increased from 29.5% in 2016 to 35.1% in 2018, with an overall prevalence of 33.6%. All S. aureus isolates were 100% sensitive toward vancomycin, linezolid, tigecycline, and teicoplanin. However, the CoNS isolates showed a higher resistance rate with reduced susceptibility toward linezolid and teicoplanin. High prevalence of resistance was observed across gram-positive isolates with commonly used antibiotics such as ciprofloxacin, levofloxacin, and erythromycin. While the prevalence of linezolid-resistant enterococcus (LRE) was 3.6%, vancomycin (VRE) and teicoplanin resistance among the enterococcus species was as high as 7.7% and 7.5%, respectively. Conclusion Rising methicillin resistance among the Staphylococcal species (MRSA and MR-CoNS) along with reduced susceptibility toward currently available anti-MRSA agents is a matter of serious concern as it limits the therapeutic options for treating multidrug resistant (MDR) gram-positive infections.

Introduction: Hepatitis B is a vaccine preventable disease caused by Hepatitis B virus which is a partially double stranded virus. Sharp injuries are the most common occupational injuries among healthcare workers (HCW). HCW are prone to sharp injuries during work, and infection after exposure. Materials and Methods: Anti-HBs titres were measured in 231 HCW in a tertiary care hospital in Mumbai. Result: Eighty six males and 145 females participated in the study. Out of these 41 were vaccine non compliant; 37 were partially immunized and 4 were not immunized. 32 out of 231 individuals tested had titres below 10 mIU/ml (10 mIU/ml considered to be the minimal protective titre). Among the individuals who had titres <10 mIU/ml, 17 were medical assistants, 10 were nursing officers and 5 were doctors. Out of these there were 04 who had not received any HepB vaccination in the past. The rest had received either complete or partial immunization. All those who had completed primary vaccination series and had titres <10 mIU/ml (n = 14) had completed primary vaccination more than 5 years ago. Conclusions: In our study 82.2% were vaccine compliant and 27.8% were vaccine non compliant. Out of 231 individuals 32 (13.85%) had titres <10 mIU/ml. This study highlights the need for HCW to undergo anti-HBs titres post primary vaccination and after 5 years of primary vaccination to identify susceptible individuals. The HCW with non protective titres should be give Hep B booster and antibody levels should be tested to confirm protective titres.

Clinical Features Associated with Linezolid Resistance Among Multidrug Resistant Tuberculosis Patients at a Tertiary Care Hospital in Mumbai, India

This study was carried out in a tertiary care hospital in Mumbai. Coagulase negative staphylococci (CoNS) which were earlier regarded as commensals have emerged as pathogenic. They have emerged as an important cause of nosocomial infections. 56 clinical isolates of CoNS were considered in the study. They were identified using tube coagulase and slide coagulase methods. S. saprophyticus was the commonest species of CoNS isolated followed by S. haemolyticus. Other commonly isolated stains were S.lugdunensis and S.epidermidis. CoNS were isolated from different clinical specimens like urine, pus, blood, HVS, catheter tips, tracheal secretions and CSF. Antibiotic susceptibility of urinary as well as non-urinary isolates was tested. All strains were found to be sensitive to Linizolid. 57% were MRCoNs.

Background: The adoption of the Medical Termination of Pregnancy (MTP) Act has allowed for abortion on the grounds of medical and social reasons since 1972.The aim of the present study is to establish the demographic of women seeking abortion care services and to determine the role of different factors in the timing of seeking an abortion.Methods: A retrospective hospital record-based study was carried out among pregnant women seeking an MTP in a tertiary care hospital in Mumbai. The records of women seeking MTP over a 5-year period from January 2012 to December 2016 were accessed and data pertaining to their demographic and obstetric history was recorded. Statistical tests of significance and analysis were done.Results: A total of 803 women underwent an MTP from January 2012 to December 2016. The number of deliveries during the same time period was 13735. The most common age group was 25-30 years. Stratification in terms of the educational backgrounds showed that 45.7% had received only secondary school education while 12.7% had no schooling. Majority of the women (74.8%) availed an MTP in the first trimester, out of which, most of them (36.9%) had 2 previous pregnancies. Most women coming in the second trimester (43.6%) hadn’t conceived before.Conclusions: Education didn’t seem to be a significant factor in determining the timing of seeking an MTP. School education did not necessarily include exposure to sexual education. Experience in terms of parity was more relevant in identifying signs of pregnancy and seeking appropriate services in a timely manner.

<p><strong>Background:</strong> The disorder of the inner ear related to abnormally increased levels of endolymph in the membranous labyrinth is called Meniere’s disease. It is well studied that the prevalence of Meniere’s disease varies widely across regions. It was found to be 13% to 42% around the world in various places. It is important to know the incidence in India to know the population suffering and to plan better treatment strategies to cater to rehabilitation strategies. Hence, the current study was planned to estimate a load of Meniere’s disease in a tertiary care hospital in Mumbai.</p><p><strong>Methods:</strong> A retrospective analysis of the case reports was undertaken. As per American academy of otolaryngology-head and neck surgery (AAO-HNS, 2020), the patients were separated as definite and probable Meniere’s disease.</p><p><strong>Results:</strong> The descriptive analysis revealed that 6 in 1000 patients reporting for hearing evaluation in a tertiary care hospital are suffering from Meniere’s disease. There was a female preponderance found in the patients with a gender ratio of 1.85:1.</p><p><strong>Conclusions:</strong> The incidence of Meniere’s disease in a tertiary care hospital in Mumbai was found to be 0.61% of all the patients tested for hearing impairment.</p>

Objective: The emergence of Carbapenem Resistant Enterobacteriaceae (CRE) in recent times has become a serious threat to public health due to the high mortality, potential dissemination rates and limited treatment options associated with these organisms. Thus, the present study was conducted in our tertiary care hospital in Mumbai, to retrospectively analyze the prevalence of CRE in the hospital. Methods: The study was carried out in the microbiology department of the tertiary care hospital over a period of 12 months. The samples tested were clinical samples from hospitalized and Out-Patient Department (OPD) patients sent to the department for microbiological testing. CRE isolates were identified using the Vitek 2- Compact system (BioMerieux, France). Results: A CRE prevalence rate of 12.26% was obtained from the study, from which the majority of the isolates were detected in urine samples (46%). Although most of the CRE isolates were detected in patient samples from the wards (42%) and the ICU (26%), a significant number of isolates was also detected from the OPD patients (19%). Conclusion: Thus, the study shows a significant rate of carbapenem resistance among Enterobacteriaceae isolated from hospitalized and OPD patients. This emphasizes the urgent need for CRE control at the hospital and community level, and to rationalize the use of antibiotics. J Microbiol Infect Dis 2013;3(4): 207-210

Clinical features associated with linezolid resistance among multidrug resistant tuberculosis patients at a tertiary care hospital in Mumbai, India

Background: Malaria is caused by parasites of genus Plasmodium. It remains a major public health concern around the world. Though various diagnostic tools are available, there is an urgent need to use a more sensitive diagnostic method for early diagnosis to prevent unwanted outcomes. Objectives: (i) To assess the prevalence of malaria in a tertiary care hospital in Mumbai (ii) To detect and speciate Plasmodium by Peripheral Blood Smear (PBS), Rapid Diagnostic Test (RDT) and real-time Polymerase Chain Reaction (PCR) and to compare their performance characteristics. Methodology: A hospital-based diagnostic study was carried over a period of 18 months. A total of 550 non-duplicated blood samples from clinically suspected cases of malaria were collected and subjected to three tests- PBS by Field’s staining, RDT and PCR to detect Plasmodium species. The agreement and the differences between the three tests were analyzed and the statistical significance was assessed using Chi-square test. Results: Out of the 550 samples, 166 (30.2%) were positive for malaria by either of the three tests, of which 92 (55.42%), 119 (71.69%) and 161 (96.99%) samples were positive by PBS, RDT and PCR, respectively. P. vivax was the predominant Plasmodium species. The most significant finding was PCR detected mixed infections in 8.43% of cases whereas PBS and RDT could detect 0% and 1.20% of mixed infection, respectively. Considering PBS as gold standard, sensitivity of RDT and PCR was 100% and 97.83% and specificity was 94.10% and 84.50% respectively. Conclusions: In this study, 30% of the population was infected with malaria with P. vivax being the predominant Plasmodium species. PCR helped identify more mono and mixed infections than conventional methods and would be a helpful adjunct for malaria diagnosis in tertiary care setup.

Current scenario of opportunistic and co-infections in HIV-infected individuals at a tertiary care hospital in Mumbai, India.

Background:Chikungunya fever (CHIK) is an arboviral disease. Dengue fever (DENG) and CHIK are indistinguishable clinically and need to be differentiated by laboratory investigations.Purpose:This study aimed at estimating the seroprevalence of CHIK mono-infection and CHIK and DENG dual infection in suspected patients. We also analyzed the age, sex distribution, joint involvement, and relation of joint movement restriction with visual analog scale (VAS).Materials and Methods:Two hundred patients clinically suspected with DENG and CHIK were enrolled from a Tertiary Care Hospital in Mumbai from April 2012 to October 2013. The detailed history and examination findings were recorded. Serum samples were subjected to DENG and CHIK immunoglobulin G (IgM) enzyme-linked immunosorbent assay (ELISA).Results:The seroprevalence of CHIK was 12.5%. Mono-infection of CHIK was 3%, and CHIK and DENG dual infection was 9.5%. Most affected age group in CHIK cases was 46–60 years wherein female preponderance was seen. All 6 patients with CHIK mono-infection had fever and joint involvement; knee and elbow were the most commonly affected joints. All CHIK patients had VAS score of 6–10 with restricted joint movement. Of the patients with dual infection, the majorities were from 31 to 45 years with male preponderance; all had fever and joint pain mainly affecting knee and elbow. Of patients who had VAS score 6–10 in patients with dual infection, only 5.26% had restricted joint movement.Conclusion:IgM ELISA for Chikungunya infection should be included in the routine laboratory tests for acute febrile illness.

Background: Pulmonary hypertension (PH) is a disorder of the pulmonary vasculature caused due to vasoconstriction, vaso-destruction, or vaso-obliteration as a complication of a varied spectrum of diseases referred to a pulmonologist. We conducted this study to contemplate the profile of PH in a tertiary care hospital in Mumbai. Methodology: This was an observational study undertaken in the department of pulmonary medicine at a tertiary care center after internal ethical committee approval. Patients with respiratory symptoms referred to us with PH as estimated pulmonary artery systolic pressure (PASP) of ≥40 mmHg by transthoracic two-dimensional echocardiography (corresponding to mean pulmonary artery pressure of ≥25 mmHg) were included in the study. The profile of these patients was studied on basis of parameters such as demography, etiology, symptomatology, radiological features, 6-min walk distance (6-MWD), and spirometry. Data were analyzed using Microsoft Excel software. Results: Among 347 patients, 54% were men. Majority of the patients (53.5%) were aged between 45 and 65 years. The most common symptom was dyspnea (86%). The most common examination finding was loud pulmonary component of second heart sound (62%). The common etiologies of PH were postinfectious obliterative bronchiolitis (OB) 30%, interstitial lung diseases 26%, chronic obstructive pulmonary disease 24%, and obstructive sleep apnea 14%. There was a negative correlation between 6-MWD, forced vital capacity % predicted, forced expiratory volume in 1st s % predicted, and PASP. Conclusion: Airway disease is the most common etiology of PH in patients presenting to a pulmonologist in India, out of which postinfectious OB forms the major bulk.