Kalinga Institute of Medical Sciences (Aug – Sep 2022)
Journal Papers
- Panigrahi, K., Pathi, B. K., Poddar, N., Sabat, S., Pradhan, S., Pattnaik, D., Patro, S & Praharaj, A.K. (2022). Colistin Resistance Among Multi-Drug Resistant Gram-Negative Bacterial Isolates from Different Clinical Samples of ICU Patients: Prevalence and Clinical Outcomes. Cureus 14(8): e28317. https://doi.org/10.7759/cureus.28317
Abstract
Introduction: Colistin is considered to be the last resort for the management of infections caused by multidrug resistant (MDR) gram-negative bacilli (GNB). However, in the recent past, there has been a rise in colistin resistance among MDR isolates in clinical settings with no profound data on the incidences and causes. The purpose of this study was to estimate the prevalence of colistin-resistance (CLR) in MDR isolates collected from different intensive care units (ICUs) and to determine the clinical outcomes of the patients. Materials and methods: A prospective study was conducted in the ICU of a tertiary care hospital in Eastern Odisha, India from March 2019 to February 2020. MDR GNB isolates from different clinical samples of ICU patients, not intrinsically resistant to colistin, were included in this study. Samples collected for culture and sensitivity testing were processed as per standard guidelines in the microbiology laboratory. MDR organisms were examined for colistin susceptibility by the broth dilution method. Clinical data was collected from hospital electronic medical records and presented as percentage, number (N), and median (range). Results: The prevalence of colistin resistance MDR GNB was found to be 19.6% in the present study. Colistin resistance among the MDR isolates was found to be the highest (9.2% for Klebsiella pneumonia followed by 5% for Escherichia coli). CLR drug-resistant isolates were commonly (28.8%) isolated from samples of respiratory tract infections and the majority (54.1%) were from neurology ICU. In this study, co-morbidity was not found among 57.9% of the ICU patients and recovery was maximum i.e., 74.2%. Conclusion: This study found the prevalence of colistin resistance to be high (19.6%) among all MDR GNB isolates from samples of ICU patients, Klebsiella pneumonia and Escherichia coli commonly acquire colistin resistance. Patients in the neurology ICU were frequently infected with CLR MDR strains. Most of the patients who recovered were without any underlying comorbidities. Prolonged hospital stay and direct antibiotic pressure in the hospital can lead to the development of CLR variants.
- Mohakud, N. K., Panda, R.K., Patra, S. D., Sahu, B.R., Ghosh, M., Kushwaha, G.S., Mishra, N & Suar, M Gut Pathogens (2022). Genome analysis and virulence gene expression profile of a multi drug resistant Salmonella enterica serovar Typhimurium ms202. Gut Pathogens 14:28. https://doi.org/10.1186/s13099-022-00498-w
Abstract
Background: In India, multi-drug resistance in Salmonella enterica serovar Typhimurium poses a significant health threat. Indeed, S. Typhimurium has remained unknown for a large portion of its genome associated with various physiological functions including mechanism of drug resistance and virulence. The whole-genome sequence of a Salmonella strain obtained from feces of a patient with gastroenteritis in Odisha, India, was analyzed for understanding the disease association and underlying virulence mechanisms. Results: The de novo assembly yielded 17 contigs and showed 99.9% similarity to S. enterica sub sp enterica strain LT2 and S. enteric sub sp salamae strain DSM 9220. S. Typhimurium ms202 strain constitutes six known Salmonella pathogenicity islands and nine different phages. The comparative interpretation of pathogenic islands displayed the genes contained in SPI-1 and SPI-2 to be highly conserved. We identified sit ABCD cluster regulatory cascade in SPI-1. Multiple antimicrobial resistance genes were identified that directly implies antibiotic-resistant phenotype. Notably, seven unique genes were identified as “acquired antibiotic resistance”. These data suggest that virulence in S. enterica Typhimurium ms202 is associated with SPI-1 and SPI-2. Further, we found several virulent genes encoding SPI regions belonging to type III secretion systems (T3SS) of bacteria were significantly upregulated in ms202 compared to control LT2. Moreover, all these genes were significantly downregulated in S. enterica Typhimurium ms202 as compared to control LT2 on adding Mn2+ exogenously. Conclusions: Our study raises a vital concern about the potential diffusion of a novel multi-drug resistant S. enterica Typhimurium ms202. It justifies this clinical pathogen to demonstrate a higher degree survival due to higher expression of virulent genes and enhanced ability of metallic ion acquisition. Keywords: Whole genome sequence, Salmonella Typhimurium, ms202, Virulence
- Dey, J., Mahaptra, S. R., Raj, T.K., Kaur. T., Jain, J., Tiwari, A., Patro, S., Mishra, N. & Suar, M. (2022) Designing a novel multi-epitope vaccine to evoke a robust immune response against pathogenic multidrug-resistant Enterococcus faecium bacterium Dey et al. Gut Pathogens 14:21 https://doi.org/10.1186/s13099-022-00495-z
Abstract
Enterococcus faecium is an emerging ESKAPE bacterium that is capable of causing severe public health complications in humans. There are currently no licensed treatments or vaccinations to combat the deadly pathogen. We aimed to design a potent and novel prophylactic chimeric vaccine against E. faecium through an immunoinformatic approach the antigenic Penicillin-binding protein 5 (PBP 5) proteins was selected to identify B and T cell epitopes, followed by conservancy analysis, population coverage, physiochemical assessment, secondary and tertiary structural analysis. Using various immunoinformatic methods and tools, two linear B-cell epitopes, fve CTL epitopes, and two HTL epitopes were finally selected for vaccine development. The constructed vaccine was determined to be highly immunogenic, cytokine-producing, antigenic, non-toxic, non-allergenic, and stable, as well as potentially effective against E. faecium. In addition, disulfide engineering, codon adaptation, and in silico cloning, were used to improve stability and expression efficiency in the host E. coli. Molecular docking and molecular dynamics simulations indicated that the structure of the vaccine is stable and has a high affinity for the TLR4 receptor. The immune simulation results revealed that both B and T cells had an increased response to the vaccination component. Conclusively, the in-depth in silico analysis suggests, the proposed vaccine to elicit a robust immune response against E. faecium infection and hence a promising target for further experimental trials.
- Pathy, B., K., Panigrahi, K., Poddar., N, Pradhan, S., Pattnaik, D. & Patro, S. (2022) Multidrug-Resistant Acinetobacter Baumannii, Associated Risk Factors, And Antibacterial Susceptibility Pattern Among Patients Attending a Tertiary Care Hospital NeuroQuantology. 20 (10): 47-53. https://doi.org/10.14704/nq.2022.20.10.NQ55006
Abstract
The acinetobacter species is a common bacterium that causes hospital-acquired infections. The bacterium is currently associated with increased mortality rates among hospitalized and ICU patients. Among the major risk factors is prolonged hospital stays. Among the Acinetobacter species, the Acinetobacter baumannii is the most prevalent and is also the most resistant to drugs. Drug resistance makes it challenging for the infection rates to be controlled, especially in a facility in India, which is a developing nation with constraints on the health system. Through a retrospective approach, this study analyzed the incidence of Acineto bacterbaumannii in tertiary healthcare centers in India. It also evaluated acinetobacter susceptibility. The results indicated that prolonged hospital stay and being immunocompromised are the major risk factors for acquiring MDRAB. The results also showed that previous antimicrobial drugs contribute to the development of drug resistant species and the prevalence of infections. There is, therefore, a need for strategies to prevent drug resistance.
- Das, P., Khuntia , P.K., Das, M., Bisoi, D., Shekar, N., & Pujari, P.S. (2022) Evaluation of Knowledge, Attitude, and Practice Regarding Hand Hygiene Practices among Inpatients of Kalinga Institute of Medical Sciences Bhubaneswar: A Preliminary Study J Pharm Bioallied Sci. 14(1):S568-S572. https://doi.org/10.4103/jpbs.jpbs_570_21.
Abstract
Background: Health-care-associated infection or nosocomial infection is defined as patients getting an infection on admission to the hospital if they were not infected or incubating the infection before admission. Hand hygiene is the most important measure that can avoid the transmission of germs and can prevent health-care-associated infections. Materials and methods: A hospital-based cross-sectional study was conducted between June 2020 to July 2021 with the objective to evaluate knowledge, attitude, and practice of hand hygiene among the inpatients of Kalinga Institute of Medical Sciences, Bhubaneswar. A predesigned structured questionnaire was used for data collection. Knowledge and attitude of the participants were assessed using prevalidated 9 point and 6 point scale. Practice of the health-care providers (HCPs) toward health hygiene observed by the patients was also assessed using 6 point scale. Results: Majority of the participants had average knowledge score (56.7%) and average attitude score (62.0%) on hand hygiene, whereas their observation on the practice of hand hygiene among HCPs has given bad score (50.7%). Males have significantly good knowledge (P = 0.0001) and attitude score (P = 0.00097) compared to female. Similarly higher educational level participants had significantly good knowledge (P = 0.0002) and attitude score (P = 0.0053) on hand hygiene. Conclusions: The findings of this study indicate that there is insufficient hand hygiene awareness among the inpatients in a tertiary care hospital population mainly among the female and less educated participants. Hence, development of community-based hand hygiene promotion programs for the general public are the need of the hour.
- Premkumar, M. & Anand, A.C. ( 2022) Overview of Complications in Cirrhosis J Clin Exp Hepatol.12(4):1150-1174. https://doi.org/10.1016/j.jceh.2022.04.021.
Abstract
Background: Cirrhosis is the outcome of chronic liver disease of any etiology due to progressive liver injury and fibrosis. Consequently, cirrhosis leads to portal hypertension and liver dysfunction, progressing to complications like ascites, variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, cirrhotic cardiomyopathy, sarcopenia, hepatocellular carcinoma, and coagulation disorders. End-stage liver disease leads to an impaired quality of life, loss of social and economic productivity, and reduced survival. Methods: This narrative review explains the pathophysiology of complications of cirrhosis, the diagnostic approach and innovative management, with focus on data from India. A comprehensive literature search of the published data was performed in regard with the spectrum, diagnosis, and management of cirrhosis and its complications. Results: There is a change in the epidemiology of metabolic syndrome, lifestyle diseases, alcohol consumption and the spectrum of etiological diagnosis in patients with cirrhosis. With the advent of universal vaccination and efficacious long-term viral suppression agents for chronic hepatitis B, availability of direct-acting antiviral agents for chronic hepatitis C, and a booming liver transplantation programme across the country, the management of complications is essential. There are several updates in the standard of care in the management of complications of cirrhosis, such as hepatorenal syndrome, hepatocellular carcinoma, and hepatic encephalopathy, and new therapies that address supportive and palliative care in advanced cirrhosis. Conclusion: Prevention, early diagnosis, appropriate management of complications, timely transplantation are cornerstones in the management protocol of cirrhosis and portal hypertension. India needs improved access to care, outreach of public health programmes for viral hepatitis care, health infrastructure, and disease registries for improved healthcare outcomes. Low-cost initiatives like immunization, alcohol cessation, awareness about liver diseases, viral hepatitis elimination, and patient focused decision-making algorithms are essential to manage liver disease in India.
7. Satapathy, S., Choudhary, V., Behera., C, Swain., R, Sharma., R & Sagar R. (2022) Adverse Childhood Experiences, Aggression, Empathy, and Psychopathology in Adult Males Accused of Rape Indian Journal of Psychological Medicine. 5 (4) 2022, 466-473. https://doi.org/10.1177/02537176221106278
Abstract
Background: Investigating the underlying psychosocial factors is a cornerstone of planning need-based intervention for adult males accused of rape. Unresolved debates on its etiology, mediation, or interaction among causal psychosocial variables fuel curiosity to scrutinize it further. Hence, we studied potential influence of and relation between adverse childhood experiences, aggression, empathy, and psychopathology in adult males accused of rape in India and investigated the risk factors for the same.
Methods: With a correlational research design, 40 literate and consenting adult males medically confirmed for rape were recruited using convenient sampling. The assessment was done on Adverse Childhood Experiences, Aggression Questionnaire, Symptom Checklist-90, and Interpersonal Reactivity Index. Descriptive statistics, Pearson’s product–moment correlation, and stepwise linear regression analysis were calculated.
Results: Approximately 75% of the participants experienced at least one category of Adverse Childhood Experiences. Scores above cut-off points were obtained on anger, hostility, fantasy, and personal distress. Significant correlations were obtained between adverse childhood experiences and psychopathology; between hostility and psychopathology, perspective taking, and personal distress; and in case of indirect aggression, with perspective taking and empathetic concerns. Regression analysis revealed that an increase in Symptom Checklist-90 global scores increases hostility and that lower personal distress predicts higher scores on hostility on Aggression Questionnaire.
Conclusions: Adverse childhood experiences, aggression, and psychopathology play a critical role and, therefore, should be included as core components of the prevention of rape or relapse prevention programs at the community level.
- Kar, S., Singh, S., Parimita, P., Mishra, A. & Panda, P.S. (2022). Awareness regarding prevention and management of needle stick injury among the health care providers in a tertiary care Hospital, Bhubaneswar, Odisha- A qualitative data exploration. Indian Journal of Microbiology Research, 9(2), 135-139.
Abstract
Background: Needle stick injuries are preventable causes of fearsome diseases like Hepatitis B and HIV. In spite of this knowledge, the health care providers are quite negligent, and the institutional support too is compromised due to the increased demand for services.
Objectives: The current study is a dipstick audit of the knowledge and practices on NSI (prevention and management) among exposed health care workers, with specific reference to HIV infection in a private health facility in Bhubaneswar city, using an unorthodox tool of Focus Group Discussions among the participants. Materials and Methods: The exercise was a part of the academic activity of health promotion on World AIDS Day 2021. Health care workers such as doctors, paramedical staff & utility staff voluntarily participated in the FGD session. Total 3 FGDs were conducted at 3 different places inside the hospital premises. Three moderators were selected previously and after discussing the theme of World AIDS Day, they guided the FGDs with similar probing questionnaires. The sessions were recorded with the help of a recorder and also noted down along with Sociograms.Result: The data gave a real picture of how even premier institutions are complacent regarding the problem. Only 27% knew about the SOPs, and in none of the stations,SOPs were displayed or a register was maintained regarding NSI in their work area. None of the participants were aware of Post Exposure Prophylaxis for the same. This indeed highlighted an ignored aspect of quality health care. Conclusion: The data was an eye-opener in a tertiary care center and from time to time there should be refresher training or sessions to increase the level of awareness.
- Nath, P., Kumar, R., Mallick,B., Das, S., Anand, A. C., Panigrahi, S.C., Duseja, A., Acharya S.K., Chawala. Y.K., & Praharaj, D.L. (2022) Effect of Nonalcoholic Fatty Liver Disease (NAFLD) on COVID-19: A Single-Center Study of 3983 Patients With Review of Literature. Cureus, 14(7), e26683. https://doi.org/10.7759/cureus.26683.
Abstract
Aminotransferase assay is often used as a screening test as well as an endpoint for resolution of disease in nonalcoholic fatty liver disease (NAFLD). Aim of the study was to evaluate the relationship of transaminase level with metabolic variables and histology in NAFLD. Single center observational study was conducted in a gastroenterology clinic at Cuttack in coastal Odisha. Subjects were consecutive patients presenting with functional bowel disease and undergoing abdominal sonography. All participants were evaluated for the presence of metabolic syndrome (MS), insulin resistance, liver function test and lipid profile. Various parameters were compared between NAFLD subjects and controls. 53.5 % of NAFLD had normal serum transaminases, whereas 20.8 % of healthy controls had transaminitis. NAFLD patients had significantly higher BMI, fasting plasma glucose, serum transaminases, serum triglycerides, serum insulin and homeostatic model assessment (HOMA) IR than controls. NAFLD patients who had transaminitis had significantly higher incidence of MS and higher mean HOMA IR than those without. There was no significant difference in histopathological features between NAFLD with and without transaminitis. To conclude, over half of NAFLD subjects do not have transaminitis while transaminitis is present in a fifth of healthy people without fatty liver. Hence serum transaminase should not be used as screening test for NAFLD. NAFLD patients with transaminitis had a higher incidence of MS and insulin resistance than those without. However, there was no significant difference in histopathological features between these two groups.
- Pathi,B. K.,Mohaptra, I., Panigrahi, K Poddar, N., Pradhan, S., ,Pattnaik,D. & Patro S (2022) Multidrug-Resistant Acinetobacter Baumannii, Associated Risk Factors, And Antibacterial Susceptibility Pattern Among Patients Attending a Tertiary Care Hospital. NeuroQuantology. 20 (10); 39-46. https://doi.org/10.14704/nq.2022.20.10.NQ55006
Abstract
The acinetobacter species is a common bacterium that causes hospital-acquired infections. The bacterium is currently associated with increased mortality rates among hospitalized and ICU patients. Among the major risk factors is prolonged hospital stays. Among the Acinetobacter species, the Acinetobacter baumannii is the most prevalent and is also the most resistant to drugs. Drug resistance makes it challenging for the infection rates to be controlled, especially in a facility in India, which is a developing nation with constraints on the health system. Through a retrospective approach, this study analyzed the incidence of Acinetobacter baumannii in tertiary healthcare centers in India. It also evaluated acinetobacter susceptibility. The results indicated that prolonged hospital stay and being immunocompromised are the major risk factors for acquiring MDRAB. The results also showed that previous antimicrobial drugs contribute to the development of drug- resistant species and the prevalence of infections. There is, therefore, a need for strategies to prevent drug resistance.
- Nayak, S., Panigrahi; K., Pathi, B. K.,, Poddar ; N.,, Pattnaik, D., Mohapatra, I,Agasthi., N & Mohakud, N. ( 2022) Association of TORCH infections and foetal outcome in women with bad obstetric history in a tertiary care hospital of Eastern India. NeuroQuantology 20 (10) 54-63. | https://doi.org/10.14704/nq.2022.20.10.NQ55007
Abstract
TORCH complex infections- Toxoplasma gondii, Rubella virus, Cytomegalovirus and Herpes simplex virus during pregnancy are linked with congenital disorder, unfavorable foetal consequences and successive reproductive failures. TORCH complex contaminations are normally mild in mother yet can be harmful to the foetus. The objective of the present study is to evaluate the seroprevalence of TORCH among women with Bad obstetric history and to find its correlation with socio-demographic characteristics and foetal outcomes. For this, we executed a cross-sectional study for a period of two years in 334 women. Blood sample analysis was conducted for the presence of specific Immunoglobulin M (IgM) and Immunoglobulin G (IgG) antibodies against each agent of TORCH complex by Enzyme Linked Immunosorbent Assay (ELISA). Statistical analysis was carried out using independent sample t-test / Chi=square tests. Our results for BOH patients showed IgM seropositivity for HSV-II was 22.64%, Toxoplasma 8.97%, Rubella 7.26%, HSV-I 6.4% and CMV 3.41% whereas, IgG seropositivity for CMV was 70.51%, Rubella 55.99%, HSV-I 42.3%, HSV-II 29.9% and Toxoplasma 19.2%. Cross infection with multiple TORCH agent was observed. TORCH positive pregnant women indicates that most of the newborns experience congenital cardiac malformation (35%), followed by Cataract (30%), Hydrocephalus (20%), and congenital rubella syndrome (15%). These Congenital anomalies are linked with multiple TORCH infections. Timely detection and early treatment of infected pregnant women can prevent transfer of infection to foetus.