Hospital Mysore Research Articles

From dysbiosis to disease: Tracing gut microbiota's role in neonatal sepsis

IntroductionNeonatal sepsis remains a critical health issue, contributing significantly to morbidity and mortality among preterm infants. Dysbiosis, an imbalance in gut microbiota, is increasingly recognized as a key factor influencing the susceptibility to sepsis. This study aims to elucidate these associations by tracing gut microbiota development in preterm neonates. Methodology: A prospective cohort study was conducted at a tertiary care hospital in Karnataka, India, involving 182 preterm neonates (gestational age <37 weeks, birth weight <1500 g) from January 2021 to September 2023. Two cohorts were defined: Cohort 1 (Healthy neonates) and Cohort 2 (Neonates with sepsis). Stool samples were collected on day 4 and day 14 for microbiological analysis. Conventional culture techniques were used to identify bacterial isolates. ResultsThe study included 182 neonates, equally divided between two cohorts. On Day 4, Cohort 1 had 45 % E. coli and 44 % Klebsiella pneumoniae, which decreased to 40.7 % and 40.7 % by Day 14, respectively. Conversely, Bifidobacterium spp. increased from 30.8 % to 52.7 %. Cohort 2 exhibited higher persistence of pathogenic bacteria, with Klebsiella pneumoniae increasing from 70.3 % to 74.7 % and E. coli from 38.5 % to 51.6 %. Mode of delivery significantly influenced gut flora, with NVD linked to higher beneficial bacteria prevalence (Enterococcus faecalis and Bifidobacterium spp.). ConclusionThe study highlights significant differences in gut microbial patterns between healthy and sepsis neonates, emphasizing the role of initial gut colonization in neonatal health outcomes. Factors such as delivery mode and prenatal antibiotic exposure significantly impact gut microbiota composition, influencing infection susceptibility.

Gram-Negative Colonization and Bacterial Translocation Drive Neonatal Sepsis in the Indian Setting.

The gut microbiota, comprising billions of microorganisms, plays a pivotal role in health and disease. This study aims to investigate the effect of sepsis on gut microbiome of neonates admitted to the Neonatal Intensive Care Unit. A prospective cohort study was carried out in the NICU of tertiary care hospital in Karnataka, India, from January 2021 to September 2023. Preterm neonates with birth weight < 1500g and gestational age < 37 weeks were recruited, excluding those with congenital gastrointestinal anomalies, necrotizing enterocolitis, or blood culture-negative infections. The study population was divided into three groups: healthy neonates (Group A), neonates with drug-sensitive GNB sepsis (Group B), and neonates with pan drug-resistant GNB sepsis (Group C). Stool samples were collected aseptically, snapped in liquid nitrogen, and stored at -80⁰C for extraction of DNA and microbiome analysis. The gut microbiota of healthy neonates (Group A) was dominated by Proteobacteria (24.04%), Actinobacteria (27.13%), Firmicutes (12.74%), and Bacteroidetes (3%). Predominant genera included Bifidobacterium (55.17%), Enterobacter (12.55%), Enterococcus (50.69%), Streptococcus (7.92%), and Bacteroides (3.58%).Groups B and C, the microbiota exhibited higher Proteobacteria abundance (57.16% and 66.58%, respectively) and reduced diversity of beneficial bacteria. Notably, the presence of sepsis was associated with an increase in pathogenic bacteria and a decrease in beneficial commensal bacteria. Neonates with sepsis exhibited significant gut microbiome dysbiosis, characterized by increased Proteobacteria and reduced beneficial bacteria diversity. These findings highlight the potential of microbiome profiling as a diagnostic tool and underscore the importance of gut microbiota modulation in managing neonatal sepsis.

Unveiling the Heartbeat of Healing: Exploring Organizational Culture in a Tertiary Hospital's Emergency Medicine Department and Its Influence on Employee Behavior and Well-Being.

This study examined the organizational culture of an emergency medicine department (EMD) in a tertiary hospital in Karnataka, India, using a prospective cross-sectional design from January to February 2024. It aimed to identify the predominant and supporting organizational cultures within the EMD and their influence on employee behavior and well-being, including job satisfaction, burnout, stress levels, and coping strategies. A total of 82 participants, including physicians, emergency medical technicians, and nurses, completed the Organizational Culture Assessment Instrument (OCAI) and a self-designed questionnaire. Ethical clearance was obtained (IEC2-656). Clan culture emerged as the dominant culture (73.17%), emphasizing collaboration and adaptability, correlated with lower stress levels and high job satisfaction (90.78%). Emotional exhaustion was the most common burnout symptom (53.66%). The coping strategies varied, with employees in Clan cultures seeking social support, while those in Hierarchy cultures sought guidance from superiors. This study highlighted the significant role of organization culture in employee well-being and EMD effectiveness, influenced by social values like respect for authority. The limitations included single-setting analysis, an uneven subgroup representation, and a lack of qualitative insights. Future research should involve multiple hospitals and qualitative methods for a comprehensive understanding.

Knowledge and awareness of bloodborne infections among medical laboratory technology students and technicians from a tertiary care teaching hospital in Karnataka, India: A cross-sectional study

Knowledge and awareness of bloodborne infections among medical laboratory technology students and technicians from a tertiary care teaching hospital in Karnataka, India: A cross-sectional study

Out-of-Pocket Expenditure for Selected Surgeries in the Cardiology Department for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Private Health Insurance, and Uninsured Patients in a Tertiary Care Teaching Hospital in Karnataka, India.

Cardiovascular diseases are a major public health issue and the leading cause of mortality globally. The global economic burden of out-of-pocket expenditure (OOPE) for cardiovascular surgeries and procedures is substantial, with average costs being significantly higher than other treatments. This imposes a heavy economic burden. Government insurance schemes like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) aim to enhance affordability and access to cardiac care. This retrospective study analyzed OOPE incurred for top cardiac surgeries under AB-PMJAY, private insurance, and uninsured patients at a tertiary care teaching hospital in Karnataka. Data of 1021 patients undergoing common cardiac procedures from January to July 2023 were analyzed using descriptive statistics (mean, median) and the Shapiro-Wilk test for normality. The study aims to evaluate financial risk protection offered by AB-PMJAY compared to private plans and inform effective policy-making in reducing the OOPE burden for surgeries in India. The study analyzed OOPE across 1021 patients undergoing any of four surgeries at a tertiary care teaching hospital in Karnataka. AB-PMJAY patients incurred zero OOPE across all surgeries. Uninsured patients faced the highest median OOPE, ranging from ₹1,15,292 (1390.57 USD) to ₹1,72,490 (2080.45 USD) depending on surgery type. Despite the presence of private insurance, the median out-of-pocket expenditure ranged from ₹1,689 (20.38 USD) to ₹68,788 (829.67 USD). Significant variations in OOPE were observed within different payment groups. Private insurance in comparison with AB-PMJAY had limitations like co-payments, deductibles, and limited coverage resulting in higher OOPE for patients. The results illustrate the efficacy of AB-PMJAY in reducing the financial burden and improving the affordability of cardiac procedures compared to private insurance. This emphasizes the significance of programmmes funded by the government in reducing the OOPE burden and ensuring equitable healthcare access. The comprehensive and particular estimates of OOPE for different surgical procedures, categorized by payment methods provide valuable information to guide the development of policies that aim to reduce OOPE and progress towarduniversal health coverage in India.

Knowledge and Practices of Airborne Infection Control at the Household Level among Pulmonary Tuberculosis Patients Attending a Tertiary Care Teaching Hospital in Central Karnataka, India

Abstract Background: Airborne transmission of tuberculosis (TB) is a major route of spread. Household contacts of TB patients are at high risk of infection. However, there is limited evidence on airborne infection control knowledge and practices among TB patients in India. This study was done to assess the knowledge and practices related to airborne infection control among pulmonary TB (PTB) patients at the household level and determine associated factors. Subjects and Methods: A cross-sectional study was conducted among 157 smear-positive PTB patients at a tertiary care hospital in Karnataka, India, using a pretested questionnaire. Knowledge and self-reported practices regarding airborne precautions were assessed. Bivariate analysis was done to determine associated factors. P &lt;0.005 was considered significant. Results: Major gaps were found in knowledge about ventilation (50.3%), avoiding visitors (39.5%), and sputum disposal (33.8%). Suboptimal practices were reported for using tissues (19%), handwashing (25%), ventilation (66%), sputum handling (54%), and waste disposal (30%). Good knowledge was associated with younger age, higher education, Hindu religion, family history of TB, intensive phase treatment, and presence of symptoms (P &lt; 0.05). Participants with good knowledge had significantly better preventive practices (P &lt; 0.00001). Conclusion: Tailored education on airborne precautions focusing on identified knowledge gaps and risky practices can help improve the adoption of infection control measures among TB patients at the household level. A multifaceted approach is required to translate improved awareness into optimal preventive behaviors.

Prevalence and Characteristics of Influenza Cases From 2017 to 2019 at a Tertiary Care Teaching Hospital in Karnataka.

Introduction Influenza virus is a significant human pathogen causing severe acute respiratory illness (SARI) associated with significant mortality worldwide. The H1N1 Influenza virus that caused a pandemic in 2009 continued to cause periodic epidemics worldwide, with new variants posing significant public health problems. The present study was carried out to determine the prevalence and characteristics of influenza at a tertiary care teaching hospital. Methods From 2017 to 2019, respiratory samples from suspected cases of influenza belonging to category C received at the microbiology laboratory were transported to Manipal Centre for Virus Research, Manipal,in the cold chain for testing of influenza virus by real-time reverse transcriptase polymerase chain reaction (rRT-PCR) as per CDC guidelines. The microbiological reports were collected and evaluated. The details of patients positive for influenza were analyzed for demographic and clinical characteristics. Results During the study period, 172 samples from SARI patients were tested, out of which 44 patients were positive for the influenza virus, accounting for a prevalence of 25.58%; 84% (n=37) of the cases were infected with H1N1 influenza virus, and the other 11.36% (n=5) and 4.54% (n=2) cases yielded H1N2 and H1N3 influenza virus, respectively. Among 44 patients, 56.81% (n=25) were females and 43.18% (n=19) were males. Most of the patients, 65.9% (n=29), were between 40 and 60 years old. The predominant presenting symptoms were fever in 81.81% (n=36) patients, breathlessness in 56.8% (n=25) patients, and cough in 54.54% (n=24) patients. Twelve (27.27%) patients had acute severe respiratory distress syndrome (ARDS). A significant mortality rate of 22.72% (n=10) was noted in the study. Conclusion A significant prevalence of influenza was noted in the study at 25.58%. Along with the H1N1 Influenza virus, the new strains detected in our region were H1N2 and H1N3 influenza viruses. Regular surveillance is important in the early detection of cases, for timely management, to reduce mortality, and to take measures to prevent the spread of this important infectious disease.

Relationship between Work-Life Balance, Job satisfaction and Employee Performance among women employees in health care sector

The present study is to investigate the influence of work-life balance on the job satisfaction and performance of female employees in the Healthcare industry. Data was gathered through a meticulously designed survey tool from a sample of 280 female employees working in various hospitals in Karnataka. The reliability of the instruments was initially assessed, followed by the use of descriptive statistics, correlation analysis, and regression analysis using SPSS. The researchers examine the function of job satisfaction as a mediator between work-life balance and employee performance using the Process Hayes Model 4. The findings reveal significant positive associations between WLB and JB, JB and EP, as well as WLB and EP. These results underscore the importance of work-life balance in fostering job satisfaction and subsequently enhancing employee performance among women in the healthcare sector. The implications of these findings for organizational policies and practices are discussed, highlighting the potential for creating supportive environments that contribute to the well-being and effectiveness of women healthcare professionals.

Correlation of RBC indices and RBC histogram obtained by automated hematology analyser with peripheral smear in the diagnosis of anemia

: The impact of early diagnosis and management of anemia on patient outcome has been tremendous. Although conventional microscopic examination of blood using peripheral smear is unequivocal, the advent of automated hematology analyzer has revolutionized the field of clinical hematology and its practice. This study highlights the efficiency and utility of specific parameters obtained by hematology analyzer and its comparison with peripheral smear in the diagnosis of anemia, also determines the sensitivity of the same.: 501 Ethylenediamine tetra acetic acid blood samples collected at a tertiary care teaching hospital in Karnataka during one and half years from February 2021 to August 2022, were run on the Sysmex 6-part automated hematology analyzer and simultaneous peripheral smears were prepared and stained using Leishman stain based on standard operating procedures. The histogram and peripheral smear findings were noted.: Among the 501 cases, there were 269(53.7%) cases of Normocytic Normochromic Anemia in which 82.9% showed normal curve, 145(28.9%) cases of Microcytic Hypochromic Anemia in which 92.4% showed shift to left, 31(6.2%) cases of Dimorphic Anemia in which 61.3% showed normal curve contrary to the expected double peak, 24(4.8%) cases of Macrocytic Anemia in which 83.3% showed shift to right, 23(4.6%) cases of Pancytopenia in which 39.1% showed normal curve and 9 cases of Normocytic Hypochromic Anemia. : The Automated hematology Analyzer provides highly valuable information with limited sample and is an essential tool in diagnosis, classification and management of anemia.

Clinical and epidemiological profile of herpes zoster cases and its complications: A prospective study

Background: The varicella-zoster virus, which is known to lie dormant in the dorsal root ganglia after primary chickenpox infection or immunization, and in rare instances, intrauterine infection, is the source of the common viral infection known as herpes zoster (HZ). In healthy people, the illness usually goes away on its own, but in severely immunocompromised patients, it can cause persistent debilitation through multi-dermatomal, severe, vesiculo-pustular, nodular, crusted, and ecthymatous manifestations. Aims and Objectives: The aim of this study was to better understand the clinical profile and epidemiological patterns of HZ and various postherpetic complications. Materials and Methods: A prospective cross-sectional study was conducted at a tertiary care hospital in Karnataka for 24 months during August 2013–August 2015. Seventy-five patients with HZ and postherpetic complications attending the dermatology outpatient department were included in the study. Pre-existing comorbidities and patient details were recorded. The Hayes and Patterson Visual Analog Scale (VAS) was used to record the kind, duration, and intensity of the pain. Results: The current cross-sectional study was done in a tertiary care hospital, and a total of 75 patients were considered for the study. The youngest patient was a 12-year-old male and the eldest patient was a 90-year-old male. The average age of patients was 52.45 ± 12.5 years. Cutaneous examination showed erythema (84%) and vesicles (84%). The intensity of pain was classified based on the VAS. About 54.6% of patients had a moderate degree of pain. Conclusion: Acute vesicles with erythema and radicular pain with a unilateral dermatomal distribution are the most typical presentation of HZ infection, and they are most frequently seen in the thoracic area.

Clinical profile of herpes zoster in human immunodeficiency virus infected at a rural-based tertiary care center

Background: Due to the reactivation of the varicella-zoster virus, which had lainissed within sensory ganglions, herpes zoster (HZ) is typified by unilateral radicular pain and grouped vesicular eruption that is typically restricted to the dermatome innervated by a single spinal or cranial sensory ganglion. It is widely known that reactivation of varicella-zoster virus infection as HZ can cause morbidity in a human immunodeficiency virus (HIV)-positive host. Aims and Objectives: The aim of this study was to describe the clinical profile of HZ among HIV-positive patients in a rural tertiary care center. Materials and Methods: A prospective hospital-based study was conducted in a rural tertiary care hospital in Karnataka for duration of 24 months. All patients attending the outpatient department (OPD) of dermatology with clinical features of HZ and post-herpetic complications irrespective of their age and gender were included in the study. Data collection done in a semi-structured questionnaire on patient particulars as well as pre-existing co-morbidities was documented. Results: A cross-sectional study included 75 HZ patients attending OPD. Among the total 75 HZ patients, 11 were found to be seropositive for HIV infection. Seroprevalence among HZ was 14.6%. Among seropositive patients, the maximum belonged to the age group 41–60 years (63.3%). In the seropositive group, maximum cases (36.4%) occurred during summer while it was in the post monsoon season (39%) in the seronegative group. Conclusion: It is known that multidermatomal and severe pain is more commonly seen in HIV-infected patients than in the normal population. Many HIV-positive patients can present with a typical presentation of zoster as seen in our study.

Volumetric Analysis of Sphenoid Sinus in Patients with Symptomatic Nasal Septal Deviation: A Cross-sectional Study

Introduction: Nasal Septal Deviation (NSD) is known to influence the anatomy of the paraseptal structures, such as the lateral nasal wall and middle turbinate, thereby causing changes in ethmoid cell volume and maxillary sinus. However, there is not much literature on the influence of NSD on sphenoid sinus volume. Aim: To evaluate the effect of NSD on the volume of sphenoid sinus. Materials and Methods: A cross-sectional study was conducted over a period of one year at a tertiary care hospital in Karnataka, India on 45 patients with symptomatic NSD. Diagnostic Nasal Endoscopy (DNE) and Computed Tomography (CT) scans of the nose and Paranasal Sinuses (PNS) were performed on all patients. NSD was classified into three types based on the degree of septal deviation on CT scan. Sphenoid sinus volumes were measured, and the relationship between NSD and sphenoid sinus volume was analysed using OSIRIX software on the MAC system. Statistical analysis was done using the Wilcoxon signed-rank test and the Kruskal-Wallis test. Results: The mean age of the patients included in the study was 30.89±10.19 years. The male-to-female ratio was 2.75:1. The majority of the patients had NSD to the right (57%). NSD was found to be 1.3 times more frequent on the right-side compared to the left. The angle of NSD ranged between 2.10° and 18°. The majority of the patients were in group I (n=35), while group II and III had seven and three patients, respectively. The total ipsilateral volume was found to be 7.43±3.46 cm3 and the contralateral volume was 7.98±4.19 cm3 . There was no statistically significant difference between ipsilateral and contralateral sphenoid sinus volumes in the population (p-value=0.781). When each group was compared, no significant difference between the total sphenoid cell volumes on the ipsilateral (p-value=0.557) and contralateral (p-value=0.405) sides of the NSD was seen. Conclusion: NSD does not affect the volume of the sphenoid sinus, irrespective of the degree of septal deviation.

To assess the knowledge, attitude, and practice about prescribing fixed-dose combinations among medical doctors in a tertiary care hospital in Karnataka: A cross-sectional study

Background: Fixed-dose combinations (FDCs) constitute a substantial portion of prescribed medications worldwide and offer benefits such as enhanced efficacy, reduced pill burden, and improved patient compliance. However, their improper utilization can lead to inefficacies, increased costs, and adverse health outcomes. The assessment of clinicians’ understanding, attitudes, and practices regarding FDC prescription at a tertiary care teaching hospital in South India serves as a crucial step toward ensuring informed and rational medication practices. Aims and Objectives: The aim and objectives of the study are to evaluate the knowledge, attitude, and practice of prescribing FDCs among medical doctors. Materials and Methods: Following approval from the Ethics Committee at Mysore Medical College and Research Institute, as well as obtaining written informed consent from medical doctors working in the institute, a selfadministered, structured, and pre-tested questionnaire was utilized. This questionnaire had been adapted from prior studies with similarities and was adjusted to align with the specific context of the present study. Results: The study of 72 doctors highlighted high FDC awareness (91.7%). The generic name of FDC was employed by 69.4% of the participants in the study. Most advocated proper prescriptions (84.8%). 57% of them identified FDC rationality. 22.2% relied on drug indexes, among other varied sources, for FDC information. Conclusion: It is essential to emphasize gaps in knowledge, attitude, and practice as it increases the risk of irrational prescriptions. Measures aiming to educate and rectify this issue, particularly in a tertiary hospital setting, help in mitigating the irrational use of drugs and optimizing patient care.

Four Cases of Laboratory Acquired Q Fever: Lessons from the Past and a Brief Review of Literature

The aim of this communication is to highlight the dangers of Q fever outbreaks in laboratories attempting isolation of Coxiella burnetii (C. burnetii) and other rickettsiae without Bio Safety Level (BSL)-3 facilities. This series is reported for the benefit of Microbiologists who evince interest in Rickettsial research. Four cases of Laboratory-acquired Q fever is presented among the laboratory personnel in a tertiary care teaching Hospital in Karnataka in 1977, which has not been reported yet. Four persons (one Lecturer, one animal technician and two M.Sc. students) who assisted in blood collection from slaughtered domestic livestock from butcheries and/or participated in the isolation of C. burnetii by guinea pig inoculation became seropositive for Q fever. The presence of antibodies to C. burnetii was demonstrated by two specific serological tests, Micro Agglutination Test (MAT) and Complement Fixation Test (CFT) for Q fever. They responded well to treatment with oxytetracycline, the drug of choice. It should be known that even microscopic demonstration of C. burnetii and other rickettsiae in the ectoparasites is hazardous, due to liberation of infective aerosol in the process. A safe commercial Q fever vaccine for laboratory and farm workers is presently available in Australia alone. Therefore, preventive measures like use of BSL-3 facility in the laboratory as well as animal house, wearing N95 face masks and protective clothing (PPE) are some of the essential precautions to follow so as to prevent laboratory acquired Q fever infection, which is an important occupational hazard.

Clinicopathological Assessment of Modified Activity and Chronicity Indices in Lupus Nephritis at a Teaching Hospital in Mysore, India

Introduction: In 20-49% of patients with Systemic Lupus Erythematosus (SLE), Lupus Nephritis (LN) is a major complication and, therefore, an important prognostic determinant of SLE. The Activity and Chronicity Indices (AI and CI), used as adjuncts to the histological classification of LN, assist in identifying patients who will benefit from immunosuppressive therapy. Aim: To investigate the correlation of AI and CI in patients with biopsy-proven LN with clinical and laboratory findings. Materials and Methods: A cross-sectional study was conducted as the Departments of Pathology and Nephrology, JSS Medical College and Hospital Mysore, India from January 2023 to March 2023, by retrieving the data of 56 patients with biopsy proven LN. AI and CI were assessed and classified. Data from multiple groups were compared using Pearson’s chi-square test, and between two groups using independent samples t-test with Statistical Package for Social Sciences (SPSS) version 21.0. Pearson’s correlation coefficient (r-value) was calculated using Microsoft excel 2021. Results: Renal biopsies from 56 cases with biopsy-proven LN were studied, with a mean age of 28±10.30 years and a M:F ratio of 1:10.2. Of the 56 biopsies studied, active lesions were seen in 47 (83.9%) and chronic lesions in 21 (37.5%). AI showed statistical significance with hypertension (p=0.049) and haematuria (p=0.005), with proteinuria (p=0.001, r=0.72), serum creatinine (p=0.037, r=0.62), and blood urea nitrogen (p=0.003, r=0.55) showing a statistically significant positive correlation. CI showed a statistically significant positive correlation with proteinuria (p=0.028, r=0.039) and serum creatinine (p=0.010, r=0.58). Both AI and CI showed statistical significance with the degree of renal insufficiency, with CI (p=0.008) displaying a stronger statistical significance than AI (p=0.012). Conclusion: In conclusion, the management and prognosis of patients with suspected LN are greatly facilitated through information obtained from renal biopsy, especially AI and CI, which are useful guides to treatment. It is important to study renal biopsy for the constellation of features in LN for better patient management.

Study of Phospholipase A2 Levels and Its Comparison With Procalcitonin Levels in Patients With Sepsis Admitted in a Tertiary Care Hospital, Karnataka, India.

Sepsis is a complicated host response to infection involving organ failure which ultimately causes death of the host. Procalcitonin (PCT) is an effective marker used to diagnose sepsis but until now, there has been no ideal marker for sepsis. Phospholipase A2 (PLA2) also increases infections; however, only a few studies have assessed its capacity as a biomarker to diagnose sepsis. Thus, we aimed to examine PLA2 and compare its diagnostic capacity and accuracy with PCT as a biomarker of sepsis. Our study was a hospital-oriented cross-sectional study. Our study group included 80 patients of both sexes older than 18 years, meeting the quick sequential organ failure assessment (qSOFA) or systemic inflammatory response syndrome (SIRS) criteria of ≥2, hospitalized in a tertiary care hospital in Karnataka, India from January 2021 to December 2021. Out of them, 59 were found to have sepsis. Samples of all the patients were evaluated for relevant parameters, and data were statistically analyzed using SPSS v21 running on Windows 10. The statistical significance was set at p-value <0.05. The mean PCT and PLA2 were significantly raised in sepsis patients compared to non-sepsis patients. Out of 59 septic patients, 45.76% had positive blood cultures, and 16.95% had positive urine culture reports. In blood cultures, the most common Gram-positive organism found was Staphylococcus, and the most common Gram-negative organism was Enterobacter. In urine cultures, Escherichia coli was the most common species. PLA2 was significantly higher in patients with bacterial etiology and Gram-positive cultures. The diagnostic capability, sensitivity, specificity, and accuracy of PLA2 were demonstrably higher than those of PCT. Our study proves that PLA2 is a much better and more efficient biomarker in sepsis than PCT. The diagnostic capacity and accuracy of PLA2 clearly surpass PCT, so using PLA2 in sepsis as a biomarker can help clinicians in deciding on timely and appropriate management to speed the recovery of patients.

Molecular and Clinical Features of Heterogeneous Vancomycin-Intermediate Staphylococcus aureus in Tertiary Care Hospitals in South India

Objectives: This study aimed to detect heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) among methicillin-resistant S. aureus (MRSA) isolated from healthcare-associated infections and identify staphylococcal cassette chromosome mec (SCCmec) types. Methods: This study was conducted from February 2019 to March 2020 and included patients admitted in 4 tertiary care hospitals in Karnataka, India. Isolation and identification of MRSA were done using standard bacteriological methods. Antimicrobial susceptibility testing was done using Kirby–Bauer disc diffusion; macrolide-lincosamide-streptogramin B phenotypes were identified using the D test. The minimum inhibitory concentration (MIC) of vancomycin was determined using agar dilution. hVISA were confirmed by the modified population analysis profile-area under the curve test. SCCmec types and the Panton- Valentine leukocidin (pvl) gene were detected using multiplex polymerase chain reaction. Results: Of 220 MRSA stains, 14 (6.4%) were hVISA. None of the MRSA isolates was vancomycin-intermediate or -resistant and all hVISA were susceptible to linezolid and teicoplanin. The macrolide-streptogramin B phenotype was present in 42.9% of hVISA; 92.9% of the hVISA strains had vancomycin MIC in the range of 1–2 μg/mL. Majority of the hVISA and vancomycin-susceptible MRSA were isolated from patients with skin and soft tissue infections. SCCmec III and IV were present in 50% and 35.7% of hVISA, respectively; 14.3% of the hVISA harboured SCCmec V. Conclusion: The prevalence rate of hVISA among MRSA was 6.4%. Therefore, MRSA strains should be tested for hVISA before starting vancomycin treatment. None of the isolates was vancomycin-intermediate or -resistant and all the hVISA strains were susceptible to linezolid and teicoplanin. The majority of the hVISA were isolated from patients with skin and soft tissue infections and harboured SCCmec III and IV. Keywords: MRSA; Hospital Infection; Molecular Typing; Vancomycin; India.

A retrospective exploratory analysis on surgical site infections in a tertiary care hospital in Karnataka

Background: Surgical site infections (SSIs) are the highest reported complications of surgery and serious postoperative nosocomial infections associated with patient morbidity, prolonged hospitalization, and economic burden. This study was conducted to estimate the prevalence of SSIs, bacterial profile, and their antimicrobial susceptibility among patients who underwent surgery and subsequent SSIs at a tertiary care hospital in a coastal district of Karnataka, India. Methods: A retrospective study was conducted by collecting the data of patients diagnosed with SSIs at tertiary care hospital during the period of four years from 2018 January to 2021 December. Data analysis was performed to estimate the prevalence of SSI, determine the bacterial profile and their antibiotic susceptibility using Jamovi software. Results: Among 95611 patients who underwent surgery, a total of 443 (0.46%) patients were clinically diagnosed with SSI. Maximum SSI cases were obtained from the Department of Orthopaedics (42.2%), followed by General Surgery (22.3%) and Neurosurgery (6.5%). Staphylococcus aureus (39.0%) was the most predominant bacteria among the isolates, followed by Escherichia coli (19.04%) and Klebsiella pneumoniae (10%). A total of 55.6% of Staphylococcus aureus exhibited methicillin resistance. Most of the bacterial isolates were susceptible to Trimethoprim sulphamethazole, Gentamycin and Amikacin. Conclusions: Though the prevalence of SSI is less it requires due attention to prevent the SSIs in the hospitals. Identification of risk factors help in planning the preventive strategies. Consistent Infection control practices are implemented in hospital for preventing the transmission of diseases, strengthening the antimicrobial stewardship program and regular antimicrobial surveillance.

Histologic pattern analysis of cutaneous basal cell carcinoma at a tertiary care hospital in South India

Basal cell carcinoma (BCC) is one of the common malignant disease of the skin worldwide. An attempt at a simplified, accurate histologic classification of BCC based on histologic growth patterns is done in this study. This paved way to the concept of risk typing BCC into low and high-risk types. This is a retrospective descriptive study of skin biopsies diagnosed as BCC between 2010 and 2018 in the Department of Pathology in a tertiary care teaching hospital in Karnataka. H&amp;E stained sections were reviewed, histopathologically subtyped and further categorized into high and low risk types. IHC for BerEP4 was done in ten diagnostically challenging cases. The patients were followed up for six months after the study period. 79 cases of BCC were studied with majority of them being classified as high risk BCC (83.54%), with nodular type (51.89%) being the most common histological subtype. BCCs were seen predominantly in patients in the sixth decade with a female preponderance in both high and low risk BCCs. Majority of the patients with genetic predispositions were of young age and included xeroderma pigmentosa and oculocutaneous albinism. IHC for BerEP4 showed strong and diffuse membranous staining in all ten cases. Recurrence was noted in two cases and metastasis following three recurrences was noted in one case. An accurate histologic classification of BCC based on growth pattern is of great significance as it reflects the biological behaviour of the tumour. Risk typing BCC into high and low risk types further guides the management of BCC. High risk categories mandate more aggressive and decisive treatment to prevent recurrences and also helps predict the prognosis for the patient.

A descriptive study of myriad risk factors in anemia of varied severity among reproductive female patients visiting a tertiary care setup in coastal Karnataka

Introduction and Aim: Anemia is common among women within childbearing age. The present study was undertaken to analyze the burden ofsocio-demographic status, lifestyle determinants, menstrual parameters, and obstetric factors as risk factors among mild, moderate, and severe types of anaemic women of childbearing age and to assess their knowledge about it.&#x0D; &#x0D; Methods: A cross-sectional study was done among 79 anemic women visiting a private medical college hospital in Karnataka. The study group was categorized into mild, moderate, and severe anemia based on the WHO criteria of haemoglobin concentration. Participants answered a validated and pretested questionnaire on their socio-demographic status, lifestyle characteristics, menstrual and obstetric history, and their knowledge regarding anemia.&#x0D; &#x0D; Results: Descriptive statistics were used for the data analysis. The prevalence of mild and moderate anemia in the rural setup was higher compared to urban living. Most of the participants with mild to moderate anemia had education up to primary schooling and were married homemakers. Participants with moderate to severe anemia belonged to the below poverty line status. There was a higher intake of white meat among moderate anemic participants compared to the other groups.Majority of the participants with mild to moderate anemia suffered from dysmenorrhoea. Only 51% of the participants knew that anemia is a health problem and most of the participants were ignorant of the features of anemia.&#x0D; &#x0D; Conclusion: We conclude that moderately anemic participants mostly belonged to rural areas, were less literate, belonging to lower economic strata, consuming white meat and junk food.