Care Hospital In Mumbai Research Articles

Multidisciplinary Approach to the Management of Aluminium Phosphide Poisoning – Experience from a Tertiary Care Hospital

A usual ingredient of rodenticide, aluminium phosphide is known for its poisoning which happens to be one of the common causes of suicides in India. Signs and symptoms of toxicity with aluminium phosphide are wellknown. Circulatory failure plays an important role in mortality with aluminium phosphide poisoning. Aluminium phosphide poisoning is associated with high mortality as there is no specific antidote available yet. There is a need for correct treatment approach to manage this fatal poisoning. In this retrospective analysis we present a data of forty cases registered at a tertiary care hospital in Mumbai. We developed a multidisciplinary treatment approach to aluminium phosphide poisoning which may help in better patient outcomes. Correct treatment protocol with supportive therapy resulted in better survival in these patients. Hence we propose this aggressive, appropriate management with continuous haemodynamic monitoring and multidisciplinary treatment approach to reduce the mortality in aluminium phosphide poisoning.

Incidence of Meniere disease in a tertiary healthcare center in Mumbai

<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>

Olfactory and Taste Dysfunction in Coronavirus Disease 2019 Pandemic.

This study is done to raise awareness of olfactory and taste dysfunction association in coronavirus disease, urging early detection and isolation of coronavirus positive patients thus breaking the chain of transmission of disease. This is a retrospective observational study done in outpatient department of tertiary care hospital in Mumbai, west India from 1st May 2020 to 1st August 2020 on patients who were confirmed positive for COVID-19 by real-time reverse transcription polymerase chain reaction (rRT-PCR) and having olfactory dysfunction and/or taste disorders. In study population, anosmia and ageusia occurred in 88% and 83.33% respectively. In control population, anosmia and ageusia occurred in 93% and 85.71% respectively. The mean duration of anosmia was around 2 weeks and 3 weeks for study and control group respectively. In study population 94.6% recovered from anosmia, whereas in control population 64.3% recovered from anosmia. Anosmia gradually improved to hyposmia. In the study population 94.3% hyposmia patients showed recovery, while in control population 85.2% showed recovery. Ageusia collaborated with the duration of anosmia. Recovery from taste dysfunction was 88.6% and 63.9% in study and control population respectively. Olfactory and taste dysfunction are very important clinical features of coronavirus positive patients with anosmia being the most prominent symptom. All patients presenting with smell and or taste dysfunction should be screened for coronavirus disease, helping in early detection in asymptomatic patients.

Culture and sensitivity pattern of aerobic bacterial isolates in diabetic foot infections, in a suburban tertiary care hospital in Mumbai

Background: The most common complication observed in patients with diabetes mellitus is diabetic foot infection; it is the bone or soft tissue infection below the malleoli. The most common pathogens involved in this infection are Staphylococcus species and beta haemolytic streptococci. Severe, chronic, or formerly dealt with infections are usually polymicrobial. Hence, the aim of the study was to understand the microbiological profile and antimicrobial susceptibility pattern of pathogens causing diabetic foot infections.Methods: Post approval from Institutional Ethics Committee, a retrospective study was carried out based on review of records of 117 patients with diabetic foot infections over two-year period from 2018 through 2019. All demographical and microbiological data was analysed.Results: Out of 117 patients of diabetic foot infections, 71 (60.68%), patients showed bacterial growth. Amongst 71 patients 45% of patients had gram positive infection. 52% patients had gram negative infection. 3% patients had poly-microbial growth. Most common organism isolated were Staphylococcus aureus 28%, Morgaellamorgagni 11%, Proteus mirabilis 9%, Citrobacter koseri 8%, E. coli 8%. Incidence of Staphylococcus aureus (MRSA and MSSA) was 3% each. Staphylococcus aureus had sensitivity to Rifampicin, Cefoperazone, Tigecycline.Conclusions: Diabetic foot infections are common complication worldwide. Understanding the microbiology will help to deal better in management and prognosis of patients. Hence, it is mandatory to characterize the causative agents, and its antimicrobial susceptibility pattern to ensure successful outcome of diabetic foot infections.

Seroprevelance Survey of Healthcare Workers in a Covid Care Hospital in Mumbai, India

Seroprevelance Survey of Healthcare Workers in a Covid Care Hospital in Mumbai, India

The Prevalence and Antimicrobial Susceptibility Pattern of Gram-Positive Pathogens: Three-Year Study at a Tertiary Care Hospital in Mumbai, India

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.

A cross sectional study to assess factors related to exclusive breast feeding practice among mothers of infants aged six months or less admitted in pediatric wards at tertiary care hospital

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.

Clinical Characteristics, Management, and Short-Term Outcome of Neonates Born to Mothers with COVID-19 in a Tertiary Care Hospital in India.

Lay summaryThe current pandemic of COVID-19 has affected all the countries globally. However, the adverse impact of the pandemic is more seen in the low-income and middle-income countries (LMICs). Although there is evidence on the adverse impact of the SARS-CoV-2 on the health of mothers and neonates, the evidence is mainly from high-income countries. For reducing the mortality and morbidity due to COVID-19 in LMICs, there is a need to generate evidence from the LMICs. The present study is a part of the National Registry of pregnant women with COVID-19 in India (PregCovid registry). Our study demonstrates a higher risk of adverse outcomes such as neonatal sepsis and death in the SARS-CoV-2 infected as compared to the non-infected neonates. The study also showed the risk of SARS-CoV-2 infection in 6.3% of neonates born to mothers with COVID-19.IntroductionWe describe the clinical characteristics, management, and short-term outcomes of SARS-CoV-2 neonates born to mothers with COVID-19 in a tertiary care hospital in Mumbai, India.MethodsThe study is a retrospective analysis of 524 neonates born to mothers with COVID-19 admitted from 14th April 2020 to 31st July 2020.ResultsSARS-CoV-2 infection was detected in 6.3% of the newborns of the mothers with COVID-19. No significant differences were observed between maturity at gestation, birth weight and sex of SARS-CoV-2 infected and non-infected newborns. The risk of sepsis was 4.09 (95% CI,1.28-13.00) fold higher in the neonates with SARS-CoV-2 as compared to the non-infected group (p = 0.031). Poor feeding was significantly more common among SARS-CoV-2 infected neonates (12.1%) as compared to the non-infected neonates (2.7%) (p = 0.017). There was a total of 13 neonatal deaths, of which 3 deaths occurred in SARS-CoV-2 infected neonates (9%) while 10 (3%) in the SAR-CoV-2 negative group. The risk of neonatal death was higher in SARS-CoV-2 infected newborns (OR 4.8; 95% CI 1.25-18.36).ConclusionNeonatal SARS-CoV-2 infection is observed in almost 6% of neonates born to mothers with perinatal COVID-19. There is a higher risk of adverse outcomes such as neonatal sepsis and death in the SARS-CoV-2 infected as compared to the non-infected neonates.

Which LDL Value Should Clinicians Look at?

Objectives LDL cholesterol is routinely estimated by the Friedewald formula to guide the treatment of dyslipidemia. However, Friedewald equation has certain limitations, especially with high triglyceride levels. Direct methods are available for LDL estimation but have received relatively little scrutiny in the Indian setting. This study was aimed at comparing the calculative and direct methods of LDL estimation in Indian hyperlipidemic patients. Materials and Methods In this observational study, data from 380 consecutive lipid profiles of patients visiting a tertiary care hospital in Mumbai were analyzed retrospectively. CHOD PAP method was used to estimate total cholesterol. Enzymatic colorimetric method was used to estimate triglycerides. Enzyme selective protection method was used to estimate HDL. Direct LDL was estimated by homogenous enzymatic colorimetric assay and very low-density lipoprotein was calculated, whereas Friedewald’s formula was used to derive calculated LDL. Results Total cholesterol values correlated positively with the LDL values measured by both methods. However, a statistically significant difference was noted between the correlation coefficients of both the methods. Triglyceride values correlated weakly with the LDL levels measured by both the methods. A weak negative correlation was observed with LDL by the calculated method, whereas a weak positive correlation existed between TG and LDL by the direct method. The difference between the correlation coefficients was statistically significant. Conclusion Both direct and calculated methods of LDL estimation have their limitations. A robust study with a larger sample size is needed to further investigate whether the differences in the different LDL estimation methods can translate to “clinical relevance” in the Indian setting.

Prevalence of Malaria 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.

Seroprevalence and Efficacy of Prevention of Parent to Child Transmission Program Over a Decade in a Tertiary Care Hospital in Mumbai, Maharashtra.

Parent to child transmission is the major mode of spread of HIV. An effective national health program (PPTCT) has been designed under NACO which helps in reducing the spread of HIV by vertical transmission and improving the life of the women and her baby. A retrospective study was done at a tertiary care hospital, including pregnant women registered and delivered, and those who came directly in labour at the hospital during a period of 10years from January 2010 to December 2019. Pretest counselling, HIV testing, Post-test counselling were done, and antiretroviral prophylaxis was given as per the NACP guidelines. Sociodemographic characteristics, obstetric outcome and efficacy of PPTCT services were analysed. Out of the 63,947 antenatal mothers included, 61,061 (95.4%) accepted HIV testing. 177 of these tested positive (0.289%) with a significant reduction in the seroprevalence over the decade. Majority of seropositive women were primigravida; housewives from urban areas, from low income and educational background and with no history of any contraceptive use. Out of 718 live births, the MTCT rate was found to be 4.5% at 6weeks over the whole decade and was noted to be 1.8 % at 18 months which is well within the goal of PPTCT program and hence elucidating the success. Seventy-four spouses of the 177 seropositive women tested positive, 55 tested negative and 49 did not undergo the HIV testing. Decline in the number of partners not undergoing testing was elicited. The discordant couple rate in the study was 31% and showed variable trend over the decade. Our study has observed an overall increase in efficacy of PPTCT in terms of increased utilization of PPTCT through the decade, decrease in the vertical transmission and seroprevalence rate, increase in the acceptance rates of HIV testing by partner almost conquering the goal of NACO.

Sarcoidosis at the Pulmonary Medicine Department of a tertiary care hospital in Mumbai. Our experience and The New Modified Criteria Clinical Radiological Physiological (TNMC CRP) score for sarcoidosis: A novel proposition to assess the functional status.

Sarcoidosis is a multisystemic granulomatous disease most commonly involving the pulmonary system and having a myriad of manifestations. However literature is scanty pertaining to the profile and scoring system in sarcoidosis. This study was undertaken to understand the profile of sarcoidosis and an endeavor to assess the functional status with a simplified scoring system. This was an observational study undertaken in the department of Pulmonary Medicine at a tertiary care. The profile of these patients was studied in terms of clinical features, radiological findings, the New Modified Criteria Clinical Radiological Physiological (TNMC CRP) score, six-minute walk distance (6MWD), spirometry, arterial blood gas parameters, serum angiotensin converting enzyme (ACE) levels and tissue biopsy histopathology. The 68 patients included 41 women and 27 men with a mean age of 42.7 years. They comprised of 18 (27%), 39 (57%), 4 (6%), 7 (10%) cases of stage 1, 2, 3, 4 sarcoidosis respectively. Most common presenting symptom and sign was progressive dyspnea 49 (72%), and peripheral lymphadenopathy 15 (22%). Serum ACE was elevated in 57 (83%). The average 6MWD was 360 meters. Most common high resolution computed tomography (HRCT) finding was mediastinal lymphadenopathy and peri-bronchovascular nodules. Spirometry was restrictive abnormality in 48 (96%) patients. Evidence of pulmonary hypertension (PH) was present in 32 (47%) patients. Tissue diagnosis revealed granulomatous inflammation in 51 biopsies with a transbronchial lung biopsy (TBLB) yield of 62%. The average TNMC CRP score was 5. There was a positive correlation between this score and 6MWD which was statistically significant. The score correlated with the functional status. Diagnosis of sarcoidosis warrants a comprehensive and multimodality approach. HRCT and tissue biopsy are the most important diagnostic armamentariums. Modified simplified scores help assess the functional status of the disease.

The speciation and antimicrobial susceptibility pattern of coagulase negative Staphylococci in a tertiary care hospital in Mumbai

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.

Sexual behavior and contraceptive practices: Study among married heterosexual HIV serodiscordant couples of reproductive age group attending anti-retroviral therapy centre at a Tertiary care hospital in Mumbai, India.

Background:As many as half of people with HIV who are in a long-term sexual relationship have an HIV-negative partner. Data on sexual behavior and contraceptive needs of heterosexual serodiscordant couples are scarce in India. Keeping these facts in mind, it was considered imperative to conduct a study on sexual behavior, contraceptive practices and associated high risk factors among heterosexual serodiscordant couples.Objectives:The objective of the study was to assess the sexual behavior, current contraceptive practices and various risk factors of HIV transmission among married heterosexual HIV serodiscordant couples.Materials and Methods:Descriptive study conducted at antiretroviral therapy (ART) centre from where 100 discordant couples were included, data were collected related to their sexual practices, knowledge about different contraception methods and high risk factors related to infection transmission were recorded.Results:All couples had knowledge of use of condoms (100%) while consistent usage was seen only in 18%. The high risk of HIV transmission was seen among recently married serodiscordant couples. Couples engaged in daily intercourse were more likely to have high risk of transmission (P value < 0.05).Conclusion:This study showed various risk factors for infection transmission to the seronegative partner among serodiscordant couples. Henceforth, given conception that prevention of these factors could reduce overall seroconversion rate among such couples.

Prevalence of cardiac arrhythmias in patients of obstructive sleep apnea syndrome and changes after 6 months of continuous positive airway pressure therapy

Obstructive sleep Apnoea (OSA) has generated lot of attention recently. The prevalence of OSA in adult Indian population is approximately 3.5% and the majority of these patients remain undiagnosed. OSA is associated with repeated episodes of hemoglobin desaturation and higher inspiratory effort, combined with repeated arousals during sleep. This causes repeated sympathetic and parasympathetic stimulation. This has been postulated to be associated with both electric and mechanical remodeling of the heart leading to cardiac arrhythmias. In this study, we try to find a correlation between OSA and cardiac arrhythmias and to find the type of arrhythmia as the secondary aim.This study was conducted over three year period at a tertiary care hospital in Mumbai. We screened 186 patients with proven OSA (Apnoea Hypopnea Index> 5). Among these, those with pre-existing structural heart disease or arrhythmia or those not consenting for the study were excluded. 121 subjects were taken up for the study. 01 was lost to follow up, leading to a final sample size of 120. These 120 patients with proven OSAand no pre- existing cardiac pathology were subjected to 24 hour ambulatory Holter monitoring to determine the prevalence of cardiac arrhythmias among this cohort. It was found that 30% of this population had some or the other arrhythmia. (n = 36). Various factors such as age, metabolic and endocrine ailments and others were also accounted for.In the follow up to this study, these 36 patients were advised to use CPAP. Following 06 months of effective CPAP use, these subjects underwent repeat 24 hour Holter examination. Unsurprisingly, significant reduction in prevalence of cardiac arrhythmia was noticed. Now, out of this cohort of 36 subjects, only 02 were found to have cardiac arrhythmia.

Characterisation of Candida in Vulvovaginitis Patients with Special Reference to Non- albicans from a Tertiary Care Hospital in Mumbai, India

Introduction: Vulvovaginal Candidiasis (VVC) is one of the commonest vaginal infections caused by Candida spp. affecting women of reproductive age group. Though Candida spp. is of endogenous origin several host related and behavioural factors can contribute to the development of infection. Candida albicans is the commonest spp. responsible for infection. However, an increasing emergence of Non-albicans Candida (NAC) has led to the development of recurrent infections, treatment failure and complications. Aim: To characterise Candida spp. isolated from clinically suspected cases of VVC. Materials and Methods: It was an observational prospective study done during the period of May 2017 to Oct 2018. A total of 150 vaginal isolates from samples of vaginal discharge were included in the study. Candida spp identification was done by various methods like gram stain, germ tube test, culture on Sabouraud Dextrose Agar (SDA), Dalmau culture on corn meal agar, colour differentiation on CHROMagar (Chromogenic agar) and sugar assimilation tests. Statistical Package for Social Science (SPSS) was used for statistical analysis. Results: Women of age group 26-35 years were most commonly affected population. Candida albicans (49.3%) and NAC (50.7%) both were present in almost equal number. The commonest isolate found was Candida albicans (49.3%) followed by Candida glabrata (29.3%) and Candida tropicalis (21.4%). Conclusion: Highest infection rate (54%) was seen in the women of age group 26-35 years. Candida albicans being the commonest spp. As NAC are emerging rapidly, speciation will play a vital role in appropriate selection of antifungal agents for the treatment of fungal infections prior to the initiation of therapy.

The Value of AI Based CT Severity Scoring System in Triage of Patients with COVID-19 Pneumonia as Regards Oxygen Requirement and Place of Admission

Background: An important component of a pandemic like Covid 19 is to triage patients in order to prevent medical establishments from getting overwhelmed. The objective of our study is to find whether an initial HRCT chest can help triage patient by determining their oxygen requirement, the place of treatment, laboratory parameters and the risk of mortality and to compare 3 CT scoring systems (0-20 model, 0-25 model and percentage of involved lung) to find if one is a better predictor of prognosis than the other. Methods: This was a prospective observational study conducted at a Tertiary care hospital in Mumbai, India. Data collected included baseline demographics, days from swab positivity to CT scan, comorbidities, place of treatment, laboratory parameters, oxygen requirement and mortality. We divided the patients into mild, moderate and severe based on 3 criteria - 20 point CT score (OS1), 25 point CT score (OS2) and opacity percentage (OP). CT scans were analyzed using CT pneumonia analysis prototype software (Siemens Healthcare version 2.5.2, Erlangen, Germany). Findings: 740 patients were included in our study. All the 3 scoring systems showed a significant positive correlation with oxygen requirement, place of admission and death. No correlation with the laboratory parameters could be found. Based on ROC analysis a score of 4 for OS1, 9 for OS2 and 12.7% for OP was determined as the cut off for oxygen requirement. Interpretation: An early CT scan in patients affected with Covid 19 is predictive of the oxygen requirement of the patient. As severity scores increase the chances of requirement of higher oxygen and intubation increase. The severity scoring system can be based on lobar involvement and scored 0-20 or 0-25 or based on percentage of lung involved, as they are all predictive of oxygen requirement. CT severity scoring using an automated deep learning software programme is a great boon for determining oxygen requirement and triage.Funding Statement: No grant from any funding agency was received for this research.Declaration of Interests: We do not report and conflict of interest.Ethics Approval Statement: The Ethics Committee waived the need for ethical clearance and informed consent for this non-interventional study.

Prevalence of urinary tract infections and current scenario of antibiotic susceptibility pattern of bacteria causing UTI

Introduction: Urinary tract infection (UTI) is one of the most prevalent diseases affecting people of all age groups i.e. from neonate to geriatric age group. Widespread use of antibiotics has led to the emergence of resistant microorganisms. As the antibiogram of the microorganisms are frequently changing hence the present study was done to analyze the recent antibiotic sensitivity pattern of uropathogens in urinary tract infection. Materials and Methods: In present study is a retrospective analysis of culture results of urine samples, was conducted at Microbiology department of tertiary health care hospital in Mumbai. The age & sex of patients, the organism isolated and also the antimicrobial susceptibility profiles were collected from the laboratory registers using a standard data collection form. Results: The overall prevalence of UTI was 33.54% of which 66.78% were females and 33.22% were from males. High prevalence was observed in females as compared to males (2:1). Though the overall prevalence was high in old aged (>45 years) patients, in females high prevalence was seen among middle-aged (31 to 45 years) patients and in male high prevalence was seen among old age (>45 years) patients. From total 584 uropathogens, E.coli (53.77%) was the commonest isolate causing UTI followed by Klebsiella pneumoniae (27.40%). The most effective antimicrobial agents in our study were Meropenem, gentamicin, Nitrofurantoin and Cotrimoxazole whereas higher resistance was observed among Fluoroquinolones, Amoxicillin and third generation Cephalosporins, these are the drugs which are commonly given emperically for UTI. Conclusion: As drug resistance among bacterial pathogens is vary with time to time regular surveillance and monitoring is necessary for giving updated information to physician for most effective empirical treatment of UTIs. Keywords: Urinary tract infection, Prevalence, Antibiotics resistance, Uropathogenes.

Analysis of Clinical Presentation, Investigations, Admissions and Mortality Among Patients Presenting to Emergency Departments

Introduction: Characteristics of patients presenting to Emergency Department (ED) are important in order to plan future strategies and improve quality assurance. However, very few tertiary hospitals routinely utilize the patient data to improve the quality of health care services. In this study we aim to analyse the characteristics of patients presenting to ED in a tertiary care hospital in India. Methods: This retrospective observational study included 1124 adult patients presenting to the Emergency department from May, 2018 to August, 2019 at a tertiary care hospital in Mumbai. Patient demographic details, laboratory investigations and clinical outcomes were assessed. Results: Out of 1124 patients, 899 were taken up for analysis wherein 61% were males and 39% were females. Fever (13.9%) was the most common complaint noted which was followed by abdominal pain (12.6%) and chest pain (11.1%). Of the total number of patients, 58%were managed successfully in the emergency room while 30.6%patients were admitted to wards and 10%patients were shifted to the ICU. The most common investigations conducted were blood glucose (31.6%), complete blood count (31.5%) and electrocardiography (31.4%). 42.05% patients were admitted to the hospital, 18% patients left against medical advice, while more than a quarter of patients (37.05%) were discharged and 1.45% patients succumbed to death. Conclusion: Demographic and characteristic data obtained through the hospital’s information management system, provided a holistic snapshot of patients visiting the emergency department which will help us in carving out strategies in regulating the ED training programmes, planning adequate infrastructure and developing faculty resources.

Role of GeneXpert MTB/Rif in detection of tuberculosis from clinical samples: A report from a tertiary care hospital in Mumbai

Introduction: Tuberculosis (TB) causes severe morbidity and mortality in millions of people every year, worldwide and India in particular. Hence this study was undertaken to find out the role of the widely used GeneXpertMTB/Rif test in tuberculosis detection. Materials and Methods: A total of 155 samples (pulmonary and extrapulmonary) from patients clinically suspected to have tuberculosis were received for testing by ZN (Ziehl-Neelsen) stain and GeneXpert/MTB Rif. These samples were also processed for histopathology or cytology and mycobacterial culture on request of clinician. The results were studied and compared. Result: Out of the total samples received, lymph node aspirates were 23%,pleural fluid 20%,sputum 19%,pus 10%,tissue 8%,ascitic fluid 8%,cerebrospinal fluid 7%,endometrial tissue 3%,synovial fluid 1% and urine 1%.Nine sputum samples (31%) were positive by GeneXpertMTB/Rif of which two were negative on smear, two positive on culture and there was no culture request for the remaining seven samples.29 (23%) extrapulmonary samples were positive by GeneXpertMTB/Rif out of which there was no culture request for 16 samples. One sample which was negative by GeneXpert MTB/Rif grew Atypical Mycobacteria on culture. Four isolates were detected as rifampicin resistant by GeneXpertMTB/Rif but none of them were sent for Drug Susceptibility Test (DST). Conclusion: GeneXpertMTB/Rif should be used in combination with other tests for diagnosing tuberculosis. Keywords: Drug resistant tuberculosis, GeneXpert/MTB Rif, Nucleic-acid amplification test.