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Objectives: The present study was undertaken to understand the microbiological profile, clinical presentation, associated bacteraemia and present antibiogram pattern of various isolates from patients with biliary tract infection admitted in a tertiary care centre in India. Methods: In this retrospective study, Bile samples were collected from adult patients admitted in our hospital and were processed as per standard protocol. The results were interpreted as per Clinical Laboratory Standards Institute (CLSI) 2020 guidelines. Bacterial isolates were categorised as MDR and PDR as per CDC. Results: 326 bile samples were sent for aerobic culture and susceptibly testing. 197 (60.42%) of these samples were culture-positive, and the remaining 129 (39.57%) were sterile in nature. A total of 289 pathogens were isolated; Escherichia coli (37.37 % n=108) was predominant, followed by Klebsiella pneumoniae (25.60%, n=74). 170 (60.49%) isolates were resis­tant and the remaining 111 (39.50%) were susceptible to various drugs tested. 27 ESBL producing strains of E.coli( n= 20) and Klebsiella spp (n= 7) and 21 CRE producing strains of E coli ( n= 12) and Klebsiella spp( n=9) were reported . 5 isolates of Klebsie­lla spp. and a single E.coli were PDR and susceptible to colis­tin (MIC =0.5 mcg/ml) by microbroth dilution test. Conclusion: The soaring rates of infection mainly by gram-negative bacteria are a red flag with the emergence of multidrug resistant organisms and change in the anti-microbiological spectrum and pattern of biliary tract infections, there is an urgent need for the empirical and prophylactic an­timicrobial therapy in every clinical setting.

Background and Purpose: Trichosporon species are ubiquitous in nature which are associated with fatal opportunistic invasive infections, especially in immunocompromised patients. The present study aimed to evaluate the epidemiological and clinical details, as well as the antifungal susceptibility pattern of the patients with Trichosporon infections. Materials and Methods: In total, 50 clinical isolates of Trichosporon species from various samples were included in this study. The samples were isolated over a period of 18 months from patients in a tertiary hospital in North India. The isolates were characterised phenotypically with Vitek MS (bioMérieux, France). Trichosporon spp. were isolated from urine (30%), nail (30%), tissue (16%), pleural fluid (14%), and sputum (5%). In total, majority of the isolates were of Trichosporon asahii (92%),followed by Trichosporon mucoides (6%), and Trichosporon ovoides (2%). It is noteworthy that most of the reported cases were from intensive care unit (34%). Results: Intravenous catheters, antibiotics, and antifungal uptake were significantly associated risk factors with Trichosporon infection. All invasive isolates were observed to be resistant in vitro to caspofungin and exhibited high minimum inhibitory concentration (MIC) values against amphotericin B, fluconazole, and 5-flucytosine. The MICs for voriconazole and posaconazole were low. Conclusion: Trichosporonosis is being increasingly reported all around the world,including India. The results of this study highlighted the importance of early detection and treatment for this emerging yeast and also added to the ongoing surveillance for the antifungal susuceptibility pattern for this fungus.

Varicella-zoster virus (VZV) is a DNA virus belonging to the Herpesviridae family. Primary infection causes chickenpox followed by latency in the sensory ganglia, which can sometimes reactivate leading to herpes zoster. Chicken pox is generally a mild disease of childhood with a secondary attack rate of >85%, but disseminated VZV infection with visceral involvement and fatal outcome may occur in immunocompromised individuals. Indian Academy of Pediatrics recommends two doses of live-attenuated varicella vaccine in healthy unexposed children at 15-18 months and then at 4-6 years of age. The effectiveness of a single dose of vaccine is around 85% and with a two-dose schedule is as high as 92%. Despite the vaccine-induced protection, community-acquired VZV infections still remain a problem in immunocompromised population. We hereby report a case of a previously immunized pediatric liver-transplant recipient who acquired VZV infection. This case report clearly highlights the importance of strict environmental infection control practices, early suspicion, diagnosis, and management in such cases.

BACKGROUND Dexmedetomidine a highly selective α2 ‑ adrenoreceptor agonist and esmolol an ultra ‑ short‑acting β1 ‑ cardioselective adrenergic receptor blocker appear to be quite suitable to control the detrimental effects of laryngeal and tracheal stimulation. The study was conducted to compare the efficacy of dexmedetomidine and esmolol for attenuation of hemodynamic responses to laryngoscopy and intubation METHODS 200 patients of age 18–60 years, belonging to American Society of Anesthesiologists (ASA) physical state of I & II of either are posted for elective surgical procedure randomized into two groups of 100 each to receive dexmedetomidine (Group D): 1 μg / Kg in 20 mL normal saline over 10 mins, 7 min. prior to intubation and esmolol (Group E) : 1 mg / Kg over 1 min, 2 min prior to intubation. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) any side effects associated with the drugs during the study, i.e., 15 min of intubation, were observed and statistically analysed. RESULTS A statistically significant difference (p < 0.01) between Groups D and E was observed in mean heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) during intubation, 1 min, 3 min, 5 min & 15 min after intubation. CONCLUSIONS Dexmedetomidine was better as compared to esmolol in attenuation of hemodynamic response to laryngoscopy and tracheal intubation.

BACKGROUND Ketofol analgesia is considered a safe and useful technique as an alternative to general anaesthesia. The present study aimed to evaluate the use of “ketofol” as sedative in mastoid exploration performed under local anaesthesia. METHODS 100 ASA grade I and II physical status patients aged 15 to 60 years were divided in to four equal groups of 25 patients each. Group I – Propofol / ketamine (2:1) infusion @ 2.5 mg / Kg / hr.; Group II – Propofol / ketamine (2:1) infusion @ 1.5 mg / Kg / hr.; Group III – Propofol / ketamine (3:1) infusion @ 2.5 mg / Kg / hr.; Group IV – Propofol / ketamine (3:1) infusion @ 1.5 mg / Kg / hr. RESULTS There was significant decrease in BP from baseline in all groups after induction. Significant hypotension was noted in one patient of group 3 (4 %) which was corrected by IV RL infusion (10 mg / kg). Difference between group III and others was insignificant. All patients had decrease in HR from baseline, maximum decrease in group II (p

Trichosporon species are basidiomycetous yeast-like organisms found ubiquitous in nature. They are increasingly been recognized as opportunistic pathogens capable of causing life-threatening invasive diseases (trichosporonosis), especially in immuno-suppressed patients and rarely in immuno-competent patients too. Earlier multiple members of the genus Trichosporon were clubbed together as T. beigelli but after the advent of molecular techniques, more than 50 different subspecies and around 16 different strains causing human diseases are reported. It is known to cause a wide range of diseases, from superficial to probable and proven invasive diseases to summer hypersensitivity. The ability of Trichosporon strains to form biofilms on implanted devices, glucuronoxylomannan in their cell walls, and production of proteases and lipases lead to the virulence of this genus. This ubiquitous fungus exhibits intrinsic resistance to echinocandins, variable minimum inhibitory concentrations (MIC) for amphotericin B, and moderate susceptibility to fluconazole and Itraconazole, which are the commonly used anti-fungal agents for any invasive fungal infections which lead to the re-emergence of this notorious yet neglected pathogen and hence the reports of breakthrough infections among patients receiving these antifungals. This review is to understand the epidemiological, clinical details, and antifungal susceptibility pattern of various Trichosporon infections and it highlights the importance of early detection and treatment for this emerging yeast and also will add to the ongoing surveillance for the anti-fungal susceptibility pattern for this fungus.

BACKGROUND: Health care-associated infections (HAIs) are associated with high morbidity, mortality, and costs in the health-care sector. Large proportions of HAIs are preventable by following infection prevention activities such as hand hygiene (HH) and biomedical waste management (BMWM). AIM: The aim was to evaluate the effectiveness of a structured teaching session on the cognitive and psychomotor domains of BMWM and HH practices in a tertiary health-care institute. MATERIALS AND METHODS: Every participant was evaluated for pretest knowledge assessment using a prestructured format along with skill demonstration. The training included interactive sessions, open discussion, and demonstration of various skills with the active participation of various participants by trained faculty and infection control nursing officers. On completion, every participant underwent posttest evaluation. RESULTS: During 11-month study period, 450 health-care professionals (HCPs) participated in the training program. Cognitive domain score increased from 16.3 ± 2.4 to 21.3 ± 2.0 from pre- to post-test, respectively. In psychomotor domain, pre- and post-test scores for HH were 8.3 ± 3.5 and 14.3 ± 1.4, for BMWM, the corresponding values were 8.6 ± 2.1 and 9.8 ± 0.7, respectively. Overall change in the mean (± standard deviation) score between pre- and post-test for various domains of assessment was 5.0 (±2.7), 6.0 (±3.5), 1.1 (±1.8), and 12.2 (±5.3) for knowledge, HH skill demonstration, BMW segregation skill, and cumulative assessment, respectively. CONCLUSION: The initiation of a structured training program can result in a significant increase in participants’ cognitive and psychomotor domains of learning, which may have an indirect impact on the prevention of HAIs.

BackgroundCorona virus disease 2019 (COVID-19) which initially started as a cluster of pneumonia cases in the Wuhan city of China has now become a full blown pandemic. Timely diagnosis of COVID-19 is the key in containing the pandemic and breaking the chain of transmission. In low and middle income countries availability of testing kits has become the major bottle neck in testing. Novel methods like pooling of samples are the need of the hour.MethodExtracted RNA samples were randomly placed in pools of 8 on a 96 well plate. Both individual RNA (ID) and pooled RNA RT-qPCR for the screening E gene were done in the same plate and the positivity for the E gene was seen.ResultsThe present study demonstrated that pool testing with 8 RNA samples can easily detect even up to a single positive sample with Ct value as high as 38. The present study also showed that the results of pool testing is not affected by number of positive samples in a pool.ConclusionPooling of 8 RNA samples can reduce the time and expense by one eighth, and can help expand diagnostic capabilities, especially during constrained supply of reagents and PCR kits for the diagnosis of SARS-CoV-2 infection.

Introduction: Epidural analgesia is considered at present to be the most effective and innocuous technique of providing labor analgesia. The present study aimed to compare the efficacy of 0.0625% bupivacaine + 0.0002% fentanyl V/S 0.125% bupivacaine for the labor analgesia and motor blockade and also evaluated the two drug regimen for their effect on ambulation. Material and Methods: 40 ASA1 physical status female were divided into two groups. Group A comprised of 20 patients who received 0.0625% bupivacaine and 0.0002% fentanyl. Group B comprised of 20 patients who received 0.125% bupivacaine. Results: Mean time to effective analgesia was 35.71+13.84 min in group A and 18+8 min in group B and was significantly higher in group A than in group B (p value

Case Primary infection by Actinomyces is uncommon because susceptibility to infection requires breakdown of the normal protective mucosal barrier. Furthermore, involvement of the upper extremity is rare. This case report presents clinical, radiological, and pathological findings in a 26-year-old patient with actinomycosis of the hand that was treated successfully by pharmacotherapy alone without any surgical debridement. Conclusion Primary actinomycoses of the hand and upper extremity present as a challenging condition. It requires a high index of clinical suspicion and histopathologic diagnosis to guide treatment, typically involving antimicrobial therapy. This case highlights the usefulness of conservative treatment with antimicrobial therapy without surgical debridement.

Scrub typhus and leptospirosis are zoonosis and systemic febrile illnesses with diverse, nonspecific clinical manifestations, and shared risk factors for coinfection. Diagnosis of the coinfection is dependent on laboratory serological tests, which are under used. A coinfection from Uttarakhand Himalayan region is not yet reported. A 25-year-old man from altitude of 2126 feet above sea level presented with fever, myalgia, jaundice, oliguria, mental confusion, and tender hepatomegaly. Investigations revealed leukocytosis, thrombocytopenia, impaired liver function tests, renal dysfunction with neurological involvement. Leptospira immunoglobulin IgM enzyme linked immunosorbent assay (ELISA) and scrub typhus immunochromatography test were positive. This coinfection is first to be documented in this holy Indian Himalayas. Clinical suspicion, early laboratory diagnosis, and early treatment could prevent complications and fatal outcomes. Coinfection of this type may be considered when there is persistence of fever and a treatment response to doxycycline.