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Background and Aim: Enteric fever is a systemic febrile disease caused by Salmonella enterica serovars Typhi and Paratyphi. Culture provides a conclusive diagnosis of enteric fever. The main difficulties are a longer turnaround time and practicality in a developing nation with a huge population. The two RDTs that are now most often used are TUBEX-TF and Enterocheck-WB, where TUBEX-TF can identify IgM antibodies against S. Typhi and S. Paratyphi which are anti-O9 and anti-O2. The aim of this study was to evaluate the performance of the TUBEX-TF test in a typhoid fever endemic area of North India. Materials and Methods: In this cross-sectional study, we have performed TUBEX-TF, Enterocheck-WB /Immuno-chromatographic card test, Enzyme linked immunosorbent assay (ELISA), and Widal tests on the sera of 94 clinically suspected cases of enteric fever It was a cross-sectional comparative study that was carried out at a tertiary care institute in North India. In the present study, the ELISA test was taken as a comparative reference test. Results: ELISA, TUBEX-TF, Widal, and Immunochromatographic card test were performed on serum samples collected from 94 clinically suspected enteric fever cases, in which 50(53.19%) were positive by ELISA, 45 (47.87%) were positive by TUBEX- TF, 40 (42.5%) were positive by Typhidot and 19 (20.2%) were positive by Widal. For evaluation of TUBEX-TF, sensitivity specificity, diagnostic accuracy, positive predictive and negative predictive values, a comparison with IgM Anti-LPS ELISA test results was performed & it was found 75%,79.55%,80%,74.47%, and 77.17% respectively. Conclusion: We conclude that the TUBEX-TF test has a greater sensitivity and specificity than other rapid tests currently on the market. It is a simple, rapid test to diagnose enteric fever. The necessity for large-scale research to evaluate TUBEX-TF is necessary due to interviewer variances so that it can become a novel RDT test for the diagnosis of enteric fever.

Background and Objective: Acute pain services (APSs) in schema to its name primarily aim to manage acute postoperative pain. A meticulous and comprehensive APS leads to the prevention of acute pain developing into persistent chronic postsurgical pain. Good post operative pain relief helps in reduction of postoperative pulmonary complications. While a meaningful communication with the patient, assessment of general well being, facilitates eary discharge and functional recovery, thereby significantly contributing to the overall quality of recovery of the patient in the perioperative period. Methodology: An Anesthesia Consultant led APS team in our institute is responsible for daily clinical rounds. Effective communication with the patients facilitated early detection of detection of additional complaints such as restlessness, throat pain, nausea, vomiting, shoulder tip pain, increased drain output, urine retention, wound soakage and constipation to name a few. We could look beyond acute pain management. Results: One-year data from March 2023 to March 2024 were audited and subsequently findings were noted. Conclusion: APSs are an integral part of anesthesia management, primarily aiming at the management of perioperative pain in the best possible way. However, our study revealed other important aspects of this service, which could aid us in improving our perioperative outcomes.

Hymenolepis nana (H. nana), known as the dwarf tapeworm, is an intestinal helminth. This report highlights a case of H. nana infection in a young female from Northern India who presented with abdominal pain and achieved a favorable outcome following antiparasitic treatment. An 18-year-old female from a rural community in Kothara village, Baharaich, Uttar Pradesh, India, was diagnosed with H. nana infection. She exhibited mild iron deficiency anemia and granulocytosis but remained largely asymptomatic despite a moderate infection burden. While H. nana infections are often asymptomatic, prompt treatment is essential. Without intervention, the infection can spread within isolated rural populations. Therefore, incorporating H. nana screening into routine evaluations for intestinal parasites and treating even asymptomatic cases is vital to prevent further transmission.

Background and Aims: One major limitation of the spinal block remains the inability to extend the duration of the block intraoperatively unless planned before with spinal or epidural catheters and/or intrathecal additives. This study was designed to compare the effects of intravenous dexmedetomidine versus low-dose ketamine–dexmedetomidine combination infusion on spinal anaesthesia in lower limb orthopaedic surgeries. Methods: This randomised study was conducted in 60 patients scheduled for unilateral lower limb surgeries under spinal anaesthesia. Patients were randomised into Group D (n = 30) (0.5 µg/kg of intravenous (IV) dexmedetomidine bolus followed by maintenance infusion at 0.5 µg/kg/h) and Group LKD (n = 30) (IV bolus of 0.5 µg/kg of dexmedetomidine and 0.2 mg/kg of ketamine, followed by maintenance infusions of dexmedetomidine and ketamine at 0.5 µg/kg/h and 0.2 mg/kg/h, respectively). Ramsay Sedation Scale score of 3–4 was maintained. The t-test or the Wilcoxon–Mann–Whitney U test was used to compare the parameters between groups. Results: The mean sacral segment 1 (S1) regression time was 390.3 [standard deviation (SD):84.38] [95% confidence interval (CI): 360.13, 420.53] versus 393.23 (SD: 93.01) (95% CI: 363.04, 423.43) min in Group D versus Group LKD respectively ((P = 0.701). The number of episodes of hypotension was significantly higher in Group D (19 patients) compared to Group LKD (nine patients) (P = 0.001). Pre- and postoperative stress markers (24 h) and the incidence of postoperative nausea and shivering were comparable between the two groups (P > 0.05). Tramadol requirement in the postoperative period was significantly less in Group LKD compared to Group D (P = 0.003). Conclusion: The duration of S1 regression was similar between group dexmedetomidine (Group D) and group low-dose ketamine and dexmedetomidine (Group LKD).

Kluyvera spp. is a Gram-negative bacillus and was discovered by Kluyver and van Niel, included in the family Enterobacteriaceae. We report two cases of urinary tract infection due to Kluyvera ascorbata. The first case was a 61-year-old male, who was admitted to the nephrology department of the hospital with chief complaints of fever with chills from 1 week, abdominal pain, and difficulty in passing urine. The second case was a 29-year-old female, who presented to the medicine department of the hospital with a 4-day history of fever with associated chills and rigor, abdominal pain, chills, and weakness. These patients were treated with nitrofurantoin given orally for 7 days they recovered completely. This case series highlights the role of K. ascorbata, and in general of Kluyvera species, as an unusual but potentially dangerous pathogen, the need for prompt identification to determine potential pathogenicity in the immunocompetent as well as in the immunocompromised host, and to assess the efficacy of antibiotics such as carbapenems and nitrofurantoin.

Spinal and epidural blocks are commonly employed for pain relief during and following cesarean section. Intrathecal morphine (ITM) has been the gold standard for the same for many years. In recent times, many peripheral nerve blocks (PNBs) have been tried for postoperative analgesia following cesarean delivery (PACD). This article has reviewed the common PNBs used for PACD. The role of PNBs along with ITM has been studied and the current best strategy for PACD has also been explored. Currently, Ilio-inguinal nerve and anterior transversus abdominis plane block in conjunction with intrathecal morphine have been found to be the most effective strategy, providing lower rest pain at 6 hours as compared to ITM alone. In patients not receiving intrathecal morphine, recommended PNBs are lateral transversus abdominis plane block, single shot local anesthetic wound infiltration, or continuous wound infiltration with catheter below rectus fascia. PNBs are recommended for PACD. They have an opioid-sparing effect and are devoid of adverse effects associated with central neuraxial blocks such as hypotension, bradycardia, and urine retention. However, caution must be observed with PNBs for possible local anesthetic toxicity due to the large volumes of drug required.

Background: Achromobacter spp. is a rare nosocomial pathogen known to cause many serious infections like bloodstream infection, osteomyelitis, meningitis, urinary tract infections, corneal ulceration, peritonitis, and endocarditis. Materials and Methods: In this study, we retrospectively analyzed all the bacteriological sample records from the bacteriology database from January 2021 to December 2021 to determine the prevalence of Achromobacter spp. Result: Nine patients with Achromobacter xylosoxidans causing bacterial infection were identified, from whom five blood samples, two pus, one respiratory sample, one central venous pressure (CVP), and one cerebrospinal fluid were found positive for Achromobacter spp., among whom one was a 6-year-old patient having the same organism from two different body sites—CVP line and cerebrospinal fluid. Five patients had coinfection with another organism, whereas acute kidney injury was the most common comorbidity. Conclusion: In our single-center experience, approximately 50% of the cases with Achromobacter denitrificans bacteremia suffered from chronic kidney disease and had a history of antibiotic therapy, hospitalization, and the presence of devices. Active research on rising trends of Achromobacter spp. needs to be promoted.

Background: Carbapenems are among the last resorts in managing multidrug-resistant bacterial infections. The rise in resistance to carbapenems is a significant concern, and the production of carbapenemases that inactivate the drug is the most typical mode of resistance developed by the bacteria. Carbapenemase-producing bacteria are associated with higher morbidity and spread faster than noncarbapenemase-producing bacteria. Detection of carbapenemases is essential for epidemiological surveillance and in choosing the most efficient antimicrobial in managing the patient. Materials and Methods: We processed urine samples received in our laboratory over 6 months. Samples with carbapenem-resistant Enterobacterales were further processed for carbapenemase detection using the modified carbapenem inactivation method (mCIM), combined disc diffusion test (CDDT), Epsilometer test (E test), and modified Hodge test (MHT). The results were analyzed. Results: A total of 32.3% of Enterobacterales uropathogens showed resistance to imipenem/meropenem. The commonest isolate was Escherichia coli, followed by Klebsiella pneumoniae. Maximum positivity was detected by mCIM (89.2%) followed by CDDT (86.5%), E test (77.1%), and MHT (54%). Conclusion: In this study, we compared four phenotypic methods of carbapenemase detection and compared their diagnostic accuracy. These included CDDT, E test, MHT, and mCIM. Maximum positivity was detected by mCIM followed by CDDT and E test.

Pain management in patients with acute pancreatitis (AP) is mostly dominated by intravenous opioids. Besides their side effects, opioids also prolong the intensive care unit stay of the patient. The ultrasound-guided erector spinae plane block (ESPB) is an established intervention for postoperative analgesia. It is now also being studied for providing pain relief in AP. A lower thoracic ESPB targets sympathetic nerve fibers in addition to the dorsal and ventral rami through local anesthetic spread to the paravertebral space to provide both visceral and somatic analgesia. It could be an effective adjuvant as a part of multimodal analgesia and may significantly reduce overall opioid usage. We describe a case of AP where significant pain relief was achieved after administering a single-shot ESPB.

Background and Aims: A definitive cutoff of inferior venacava (IVC) diameter in expiration (dIVCmax) and inferior vena cava collapsibility index (IVCCI) for predicting general anaesthesia associated hypotension (GAAH) is not yet determined. Primary objective of this study was to determine the correlation of dIVCmax and IVCCI, with GAAH. Other objectives were to determine the correlation of these IVC parameters with preoperative fasting duration, temperature and humidity. The correlation of dIVCmax with patient demography was also studied. Methods: A total of 110 adult patients undergoing elective surgery under general anaesthesia were included in the study. IVC ultrasonography was done in the preoperative room, 20 to 30 minutes before shifting the patient to the operating room. Hypotension at (hypo@) 2 minutes and 10 minutes after administering vecuronium was recorded. Results: Hundred and seven patients were analysed. A significant positive correlation was present between patient height and dIVCmax (ρ = 0.25, P = 0.009). Area under receiver operating characteristics curve was 0.595 (95% confidence interval (CI) 0.485–0.705) and 0.568 (95% CI 0.458–0.679) for dIVCmax and IVCCI for predicting hypo@2 min, with a diagnostic accuracy of 54% and 53%, respectively. dIVCmax ≤1.14 cm had a sensitivity of 31% and specificity of 87% in predicting GAAH. IVCCI ≥63.3% could predict GAAH with 31% sensitivity and 84% specificity. No significant correlation was found between preoperative IVC parameters and preoperative fasting or environmental factors. Conclusion: Both dIVCmax and IVCCI have poor diagnostic accuracy, with good specificity and low sensitivity in predicting GAAH. A steady formula for calculating baseline IVC diameter adjusted for patient demography is needed.

Abstract Background Recurrent coronavirus disease 2019 (COVID-19) infection is an emerging problem and may prove to be one of the greatest problems in controlling the pandemic in the future. Recurrent infections can be due to reactivation of dormant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or reinfection with similar or different strains of SARS-CoV-2. Case presentation Here we present an interesting case of a health care worker working as a laboratory assistant at a COVID-19 laboratory who developed recurrent COVID-19 infection. He did not develop an immune response after the first episode of COVID-19; however, immunoglobulin G (IgG) antibodies were detected after the second episode. Conclusions Through this case, we discuss the concept of reactivation and reinfection in the post-COVID period. We suggest that standard guidelines should be established to check for viral shedding and immune response among cured cases of COVID-19 after discharge via serial real-time polymerase chain reaction (RT-PCR) testing and IgG antibody detection. Further, strict hygiene practices should be stressed to these patients with possibility of COVID-19 recurrence.

Objective: Healthcare-associated infection (HCAI) has become a potential peril in intensive care unit (ICU), operation theater (OT) as well as postoperative wards. Those infections are often caused by multidrug-resistant (MDR) organisms. Health-care workers (HCWs), who are taking care of sick patients, often colonize and transmit microorganism from infected to noninfected patient causing HCAIs. The purpose of this study was for surveillance of potential pathogens as hand carriage among HCWs. Materials and Methods: Hand swabs were collected from palmar surface and interdigital space of predominant hands of HCWs working in ICU, OT, and postoperative wards. Antimicrobial susceptibility profile of the potential pathogen isolates including Staphylococcus spp. was also determined for several antibiotics. Methicillin resistance was detected using cefoxitin 30 μg disc. Results: In our study, among 199 HCWs, there was a high carriage rate of Staphylococcus spp. in hands 98 (49.2%) (male: female 1:1). Among Staphylococcus spp., Coagulase-negative staphylococci (CoNS) was around 69 (34.6%) and Staphylococcus aureus was around 29 (14.5%). (including methicillin-resistant S. aureus [MRSA] and methicillin-resistant coagulase-negative Staphylococci [MR-CoNS]). Nearly 65% in MRSA and 75% MR-CoNS were macrolide resistant also. The MRSA hand carriage was significantly high in HCWs having

Introduction: The ongoing spread of pandemic coronavirus disease (COVID-19) caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) is of growing concern. Rapid diagnosis and management of SARS-CoV-2 is crucial for controlling the outbreak in the community. Here we report the development of a first rapid-colorimetric assay capable of detecting SARS-CoV-2 in the human nasopharyngeal RNA sample in less than 30 minutes. Method: We utilized a nanomaterial-based optical sensing platform to detect RNA-dependent RNA polymerase (RdRp) gene of SARS-CoV-2, where the formation of oligo probe-target hybrid led to salt-induced aggregation and change in gold-colloid color from pink to blue visibility range. Accordingly, we found a change in colloid color from pink to blue in assay containing nasopharyngeal RNA sample from the subject with clinically diagnosed COVID-19. The colloid retained pink color when the test includes samples from COVID-19 negative subjects or human papillomavirus (HPV) infected women. Results: The results were validated using nasopharangeal RNA samples from positive COVID-19 subjects (n=136). Using RT-PCR as gold standard, the assay was found to have 85.29% sensitivity and 94.12% specificity. The optimized method has detection limit as little as 0.5 ng of SARS-CoV-2 RNA. Discussion/Conclusion: We found that the developed assay rapidly detects SARS-CoV-2 RNA in clinical samples in a cost-effective manner and would be useful in pandemic management by facilitating mass screening.

Background: Preoperative anxiety plays a critical role in post-operative pain response and other outcomes. Melatonin is a naturally secreted hormone which has anxiolytic, sedative, and analgesic properties. Pregabalin, analogue of gabapentin which has property of anxiolytic and analgesic effects. Materials and Methods: Total 96 patients undergoing total hip arthroplasty, divided into 3 groups of 32 each and were given placebo (group I), melatonin 6 mg (group II), and pregabalin 150 mg (group III). Anxiety level, postoperative pain score, sedation level and duration as well as characteristics of spinal anaesthesia were assessed with other vital parameters. Results: Group I showed an increment in the anxiety score from baseline whereas in group II and group III, there was a decline in pre-operative anxiety score from baseline at all the periods of observation and more significantly in group III. Visual analogue scale (VAS) score and total dose of rescue analgesia were highest in group I, but group II and group III were comparable to each other. However, the durations of spinal anaesthesia and motor blockade showed a statistically significant difference with maximum duration in group III followed by II and then I. The level of sedation among the three groups were comparable at all the periods of observation. Conclusions: Pregabalin was found better for perioperative anxiolysis, post-operative analgesia and for prolongation of duration of spinal anaesthesia when compared to melatonin.

Introduction: Effective cardiopulmonary resuscitation (CPR) program is required in all health care organizations (HCOs). The focus is primarily on technical aspect of CPR training and managerial challenges encountered in establishment of CPR program are not discussed in detail previously. The aim was to study the managerial challenges in establishing a structured CPR program in a small HCO. A prospective, observational study conducted over a period of 3 months. All staff of the HCO was trained in basic life support. Materials and Methods: A CPR committee was constituted which formulated the CPR policy, CPR rapid response teams (CPR RRT), and training protocols and recorded observations during the study period. Statistical Analysis Used: Mean, percentage, and gain score were used for statistical analysis. Results: The major challenges encountered were unorganized work, lack of resources, old building structure with difficult to access areas, lack of knowledge upgradation, and nonmotivated staff. The clinical staff, involved in regular CPRs, although had basic CPR knowledge, they required continual refresher training. The nonclinical staff showed much larger improvement in scores post training. Conclusions: Flexible functional CPR policy with multidisciplinary CPR RRTs, low dose high frequency training, customized crash kits, interdepartmental liasoning, and mock drills were found useful in making “CPR a reflex manoeuvre” and effective implementation of CPR program. Concepts and principles implemented from organizational behavior, leadership, and motivation such as “Herzbergs Motivational hygiene theory” were useful. Continual training of staff is required for consistent delivery of high quality CPR and even nonmedical staff can be trained to provide high quality Basic Life Support (BLS) similar to clinical staff.

Background: Healthcare-associated infection (HCAI) has become a potential risk worldwide. Staphylococcus spp., especially methicillin-resistant Staphylococcus aureus (MRSA) is one of the frequent causes of HCAIs. Coagulase-negative Staphylococcus (CoNS), previously considered as contaminants, now emerged as opportunist nosocomial pathogens for causing HCAIs such as bloodstream infections. Health-care workers (HCWs) play a role in colonizing and transmit microorganism to patient causing HCAIs. The purpose of this study was for surveillance of MRSA and MR-CoNS as nasal colonizer among HCWs and its antimicrobial susceptibility pattern. Materials and Methods: Nasal swabs were collected from 214 HCWs such as doctor, nurse, sweepers, ward boy, and operation theatre (OT) assistant working in Intensive Care Unit and OT and ward. Methicillin resistance among the Staphylococcus spp. isolates were detected using cefoxitin 30 μg disc. Antimicrobial susceptibility profile of the Staphylococcus spp. isolates were also determined for several other antibiotics. Results: Of 214 nasal swabs collected from HCWs, 97.6% of doctors, 93.2% of nurses, and 94.6% of sweepers showed growth of Staphylococcus spp. MRSA was 13%, 6.7%, and 14.2% in samples obtained from anterior nares of doctors, nurses, and sweepers, respectively. MR-CoNS were 41.6%, 32.4%, and 32.1% in samples obtained from anterior nares of doctors, nurses, and sweepers, respectively. Conclusion: Multidrug-resistance Staphylococcus spp. carriage is very high among HCWs in our tertiary care center. Our study created awareness among HCWs by educating them about nasal carriage of MDR organisms.

Bordetella bronchiseptica is a pleomorphic gram-negative coccobacilli typically causing respiratory tract infections in dogs. Its infection in humans is very uncommon. B. bronchiseptica was cultured from the pus swab taken from an ulcer on the chest at the site of chemo-port in a 15-year-old girl in intensive care unit having postviral encephalopathy with cerebral palsy. It is a unique case because we could not find any prior published case report of B. bronchiseptica associated with wound infection in humans. B. bronchiseptica can be a cause of wound infection in humans. In severely immunocompromised patients, this rare organism can become an opportunistic pathogen to cause severe wound infections and medical microbiologists should keep themselves updated in diagnosing such isolates and clinicians should be mindful of their diverse clinical manifestations and limited treatment options.

Background: The risk factors for urinary tract infections (UTIs) from developed countries are not applicable to women from developing world. Objective: To analyze the behavioral practices and psychosocial aspects pertinent to women in our region and assess their association with acute first time or recurrent UTI. Materials and Methods: Sexually active premenopausal women with their first (145) and recurrent (77) cystitis with Escherichia coli as cases and women with no prior history of UTI as healthy controls (257) were enrolled at a tertiary care hospital in India, between June 2011 and February 2013. Questionnaire-based data was collected from each participant through a structured face-to-face interview. Results: Using univariate and multivariate regression models, independent risk factors for the first episode of cystitis when compared with healthy controls were (presented in odds ratios [ORs] with its 95% confidence interval [CI]): Anal sex (OR = 3.68, 95% CI = 1.59-8.52), time interval between last sexual intercourse and current episode of UTI was 250 ml of tea consumption per day (OR = 4.73, 95% CI = 2.67-8.38), presence of vaginal infection (OR = 3.23, 95% CI = 1.85-5.62) and wiping back to front (OR = 2.52, 95% CI = 1.45-4.38). Along with the latter three, history of UTI in a first-degree female relative (OR = 10.88, 95% CI = 2.41-49.07), constipation (OR = 4.85, 95% CI = 1.97-11.92) and stress incontinence (OR = 2.45, 95% CI = 1.18-5.06) were additional independent risk factors for recurrent cystitis in comparison to healthy controls. Conclusion: Most of the risk factors for initial infection are potentially modifiable but sufficient to also pose risk for recurrence. Many of the findings reflect the cultural and ethnic practices in our country.

Aim: Carbapenems are one of the last resort drugs against drug-resistant organisms and carbapenem resistance (CR) is increasingly being reported. The present study evaluated the CR pattern in general Intensive Care Unit (ICU) of a tertiary care hospital in India. Materials and Methods: This was a retrospective analysis of data collected from May 2011 to January 2012 of 40 patients admitted in the general ICU with a stay of more than a week. The clinical and demographic data, Sequential Organ Failure Assessment (SOFA) score, need for mechanical ventilation, antibiotic sensitivity reports, and outcome were assessed. The results were statistically analyzed using Student′s t-test, Mann-Whitney U-test, Chi-square test, and Fisher′s exact test, where appropriate. P < 0.05 was considered statistically significant. Results: Acinetobacter baumanii was the most common organism in tracheal samples, Pseudomonas aeruginosa in blood samples and Escherichia coli in urine samples. CR in fresh episodes was seen maximally with Acinetobacter baumanii (79%) and Pseudomonas aeruginosa (70%). Meropenem resistance (MR) was more common than imipenem resistance in CR organisms. High sensitivity among CR organisms was observed to tigecycline and colistin, and among carbapenem sensitive organisms to tigecycline, piperacillin-tazobactam combination, and levofloxacin. CR was prevalent with age >50 years (P = 0.002), ICU stay of >15 days (P = 0.002), mechanical ventilation (P = 0.003), and ventilation >10 days (P = 0.008). Mortality was more common among mechanically ventilated patients (P = 0.002) and those with higher SOFA scores on admission (P = 0.012). Conclusion: Carbapenem resistance is high in microbiological cultures of ICU patients with a stay for over a week. Acinetobacter baumanii and Pseudomonas aeruginosa were the most common CR organisms. MR was more common than imipenem resistance.

Introduction: Spotted Fever Rickettsiosis (SFR), an acute febrile illness caused by Rickettsia rickettsii, R. conorii and R. akari which is associated with considerable morbidity and mortality. SFR is one of the most covert emerging infections of the present time which is prevalent in various parts of India as shown by the increase in the number of clinically diagnosed patients in various states except Uttar Pradesh. Aim: To diagnose SFR in clinically suspected patients using serological tests and recognition of common epidemiologic situations and clinical manifestations of SFR in the state of Uttar Pradesh. Materials and Methods: Patients of all age groups presented with a diagnosis of Pyrexia of Unknown Origin (PUO) from May 2013 to February 2015 were evaluated. Testing was done using a nonspecific Weil felix test followed by more specific Enzyme Linked Immunosorbent Assay (ELISA) and a gold standard Immunofluorescence Assay (IFA) test for specific IgM antibodies against Rickettsia conorii. The data was statistically analysed on Graph Pad Prism (5.0) software by using Chi-square test. Results: Of the 432 patient samples tested by non specific Weil felix test, 200 (46.29 %) samples showed titre 1:80 or more and were taken as positive. Similarly out of the 432 blood samples tested by both ELISA and IFA based test against Rickettsia conorii IgM antibody, only 115 (26.62%) samples were found to be positive and these samples were also positive by Weil felix. The common symptoms noted were fever, hepatomegaly, thrombocytopenia, lymphadenopathy and rashes, nausea followed by icterus, cyanosis, headache, oedema and abdominal pain. Eschar was found in only four (3.4%) patients. We also found that 31 patients with SFR also had associated co-infections like typhoid, malaria, dengue and hepatitis. Conclusion: Our findings demonstrated that Weil Felix test can fill in as an underlying yet not sole strategy to perceive and analyse rickettsial ailments, as it needs specificity. So, it may be used to assess the burden in the area and later on other tests like ELISA or IFA can be added, as these are more specific diagnostic tests. Further, our results also showed that if a patient tests positive for the more common endemic infections, we must test for rickettsiosis so that appropriate treatment could be administered.

Context: The choice of irrigating solution used in root canals of primary teeth is complicated by their complex morphology and paucity of associated literature. Propolis is a natural product that has gained interest in this context due to its antibacterial effectiveness against several endodontic pathogens. Aim: The present study was undertaken to assess the potential of water-soluble 25% propolis extract against microorganisms present in root canals of primary teeth during endodontic procedures. Settings and Design: The child patients in the age group of 4-7 years with radiographic evidence of carious pulp exposure were included in the study. Definitive selection was done after gaining access into the pulp chamber and root canals of the selected teeth. The clinical and radiographic evidence of pathosis was ruled out for inclusion in the study. Materials and Methods: The selected teeth were divided into two groups randomly. In Group A 0.9% isotonic saline and in Group B 25% extract water-soluble propolis were used as irrigating solution, respectively. The bacterial samples were collected both pre- and post-irrigation and were transferred for microbial assay. Staististical Analysis: Wilcoxon matched signed rank test was used to compare the pre-and post-irrigation bacterial counts. Mann-Whitney test was used to compare the mean change (pre-post) in bacterial colony counts of groups in the study. Results: Antimicrobial effectiveness of 25% water-soluble extract of propolis in the root canals of primary teeth was confirmed in the present study. The reduction in the mean bacterial colony counts of all the isolated bacteria was noticed higher in Group B than Group A. Conclusion: The results of the present study have confirmed that the antibacterial effectiveness of water-soluble extract of propolis in the root canals of primary teeth in vivo. Considering the low toxicity concerns and antibacterial effectiveness, water-soluble extract of 25% propolis can be advocated as a root canal irrigant in endodontic treatment of primary teeth.

Aims and objectives: Landmark-guided internal jugular vein (IJV) cannulation is a basic procedure, which every anesthetist is expected to acquire. A successful first attempt is desirable as each attempt increases the risk of complications. The present study is an analysis of 976 IJV cannulations performed in adults undergoing cardiothoracic surgery. Materials and Methods: The IJV was cannulated with a triple lumen catheter using the anatomical landmarks. The following data were recorded: Patient demographics, age, sex, body mass index, diagnosis, operative procedure, operator (resident/consultant), site of cannulation (central approach, right IJV, left IJV, external jugular vein), number of attempts and duration of cannulation, length of insertion of the catheter, number of correct placements on X-ray and any complications. Results: The success rate of IJV cannulation was 100%. In 809 (82.9%) patients, cannulation was performed in the first attempt. Residents performed 792 cannulations and the consultants performed 184 cannulations. In 767 patients, the residents were successful in inserting the catheter and in 25 they failed after 5 attempts, hence, they were cannulated by the consultant. The time taken for insertion of the catheter was 6.89 ± 3.2 minutes. Carotid artery puncture was the most common complication, it occurred in 22 (2.3%) patients. Conclusion: IJV cannulation with landmark technique is highly successful with minimal complications in the adult patients undergoing cardiothoracic surgery. Basic training of cannulating the IJV by landmark technique should be imparted to all the traines as ultrasound may not be available in all locations.

Introduction: Chyluria which is endemic in many parts of the world is mainly caused by Wuchereria bancrofti. CHIT1 (chitotriosidase) is produced by macrophages and plays an important role in the defense against chitin containing pathogen such as filarial parasite. Variation in the coding region with 24 bp duplication allele results in reduced CHIT1 activity that enhance the survival of parasite which may play a role in the occurrence of disease. Aim: To examine the role of 24bp duplication of CHIT1 gene in patients of filarial chyluria (FC). Materials and Methods: A case-control study was carried out where 155 confirmed FC patients and equal number of age-, sex- and residence-matched controls without any symptoms or signs of lymphatic filariasis, confirmed by negative immunochromatographic card test (ICT) and IgG/IgM combo rapid antibody test, from a hospital-based population were enrolled. Filarial aetiology was confirmed on the basis of DECprovocative test (Giemsa staining), ICT and IgG/IgM- antifiarial antibody test. The patients positive by either of these tests were enrolled as FC cases. 24bp duplication in CHIT1 gene in FC was detected by the product size 99bp of amplified gene using polymerase chain reaction. Results: The mean ages of patients and controls were 38.25±12.09 and 35.45±12.53 years, respectively while male: female ratio was 2.4:1. The mean duration of illness in chyluria patients was 62.81±60.83 months and mean number of episodes was 2.54±1.11. Homozygous wild type, heterozygous and homozygous mutant frequencies were 10.3%, 81.3% and 8.4% in FC patients and 18.7%, 75.5%, and 5.8% in controls, respectively. The 24bp duplication in CHIT1 gene showed a significant association in Heterozygous (HT) genotype with Odd Ratio (OR) of 1.95, 95% Confidence Interval (CI) (1.01-3.77); p=0.04. However, the homozygous mutant genotype (TT) was found to be non-significant with OR of 2.61, 95% CI (0.91-7.45); p=0.07. The combination of both HT+TT was also found to be significant with OR of 2.00, 95% CI (1.03-3.85); p=0.03. Conclusion: In this study from Northern India, CHIT1 gene polymorphism showed an influence as a possible risk factor for susceptibility to FC. Further studies need to be done on a larger number of FC patients in different regions of the country.

Background: Citrobacter is an important nosocomial pathogen and its multi-drug resistant (MDR) isolates are increasingly being reported across the globe. They are known to produce extended spectrum beta lactamase (ESBL) and harbor CTX-M gene. Objective: The aim was to isolate Citrobacter sp. from clinical specimens, analyze their MDR status and look for the presence of CTX-M gene. Materials and Methods: In this prospective study, Citrobacter isolates positive for ESBL on screening, were confirmed by combined disc method along with minimum inhibitory concentration (MIC) for cefotaxime. In selected cefotaxime resistant isolates, multiplex polymerase chain reaction was done for blaCTX-M gene. Results: Of 146 Citrobacter sp. isolated, most (73%) were from admitted patients and hospital stay of >72 h and prior antibiotic intake were the most common associated factors. Maximum isolates were from pus (41.1%). Citrobacter freundii was the commonest species (49%) followed by Citrobacter koseri (28%); 79 were ESBL producers. Seventy were cefotaxime resistant as shown by MIC. blaCTX-M gene was detected in 15/40 of these isolates, all belonged to CTX-M group 1. Conclusion: Overall incidence of Citrobacter in our setup is low, but they were mostly MDR, and ESBL production was high, which is a cause of concern. blaCTX-M gene detection is important because of its rapid transmission to other bacterial species.