Kalinga Institute of Medical Sciences (KIMS) (Oct – Dec 2022)

12

Journal Papers

1.          Karunakar, P., Ramamoorthy, J. G., Anantharaj, A., Parameswaran, N., Biswal, N., Dhodapkar, R., Bhaskar, M. M., Basu, D., Das, S., & Gunalan, A. (2022). Clinical profile and outcomes of multisystem inflammatory syndrome in children (MIS‐C): Hospital‐based prospective observational study from a tertiary care hospital in South India. Journal of Paediatrics and Child Health, 58(11), 1964–1971. https://doi.org/10.1111/jpc.16129

Abstract

Aim: To study the clinical profile and outcomes in children with multisystem inflammatory syndrome in children (MIS-C).

Methods: Children aged 1 month to 15 years presenting with MIS-C (May 2020 to November 2021) were enrolled. Clinical, laboratory, echocardiography parameters and outcomes were analysed. Results Eighty-one children (median age 60 months (24–100)) were enrolled. Median duration of fever was 5 days (3–7). Twenty-nine (35.8%) had shock (severe MIS-C) including 23 (28.3%) requiring inotropes (median duration = 25 h (7.5–33)). Ten required mechanical ventilation, 12 had acute kidney injury and 1 child died. Left ventricular (LV) dysfunction was seen in 38 (46.9%), 16 (19.7%) had coronary artery abnormalities (CAA) and 13 (20%) had macrophage activation syndrome. Sixty-one (75.3%) were SARS CoV-2 positive (10 by RT-PCR and 51 by serology). Sixty-eight (83.9%) received immunomodulators. Younger age was significantly associated with CAA (P value = 0.05). Older age, LV dysfunction, SARS CoV-2 positivity, low platelet count and elevated serum ferritin were significantly associated with severe MIS-C (univariate analysis). Younger age was an independent predictor of CAA (P = 0.05); older age (P = 0.043) and low platelet count (P = 0.032) were independent predictors of severe MIS-C (multivariate logistic regression analysis).

Conclusion: Our patients had diverse clinical manifestations with a good outcome. Younger age was significantly associated with CAA. Older age, LV dysfunction, low platelet count and elevated serum ferritin were significantly associated with severe MIS-C. Younger age is an independent predictor of CAA. Older age and low platelet count are independent predictors of severe MIS-C.


2.          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. https://doi.org/10.18231/j.ijmr.2022.024

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.


3.          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. DOI 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.


4.          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. doi: 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 Acinetobacterbaumannii 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.


5.          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. | 10.14704/nq.2022.20.10.NQ55007

Abstract

TORCH complex infections- Toxoplasmagondii, 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 IgMseropositivity for HSV-II was 22.64%, Toxoplasma 8.97%, Rubella 7.26%, HSV-I 6.4% and CMV 3.41% whereas, IgGseropositivity 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.


6.          Singh, P., Mohanti, B. K., Mohapatra, S. K., Deep, A., Harsha, B., Pathak, M., & Patro, S. (2022). Post-COVID-19 Assessment of Physical, Psychological, and Socio-Economic Impact on a General Population of Patients From Odisha, India. Cureus, 14(10), e30636. https://doi.org/10.7759/cureus.30636

Abstract

Aim: This prospective cross-sectional study evaluated the physical, psychological, and socioeconomic impacts of post-COVID-19 conditions (PCC) in a generalized population from Odisha, India.

Materials and methods: The study protocol and clinical record form (CRF) were approved by the Institutional Ethics Committee. Those above 18 years and of all genders who had recovered in the last six months, whether hospitalized or not hospitalized after the COVID-19 diagnosis, were included in our study.

Results: A total of 198 persons with a median age of 41 years (18-87 years) were enrolled at the post-Covid clinic. For COVID-19 management, 91 persons (46%) were hospitalized, and the remaining 107 (54%) were non-hospitalized. Five dominant clusters of physical symptoms were present – fatigue (82.8%), cough (54%), breathing difficulty (54%), pain in the body (53%), and sleeplessness (51%). The psychological issues faced were fear (41.6%), worry (40.4%), depression (31.8%), and anger (30.3%). The median monthly income in Indian Rupees (INR) for pre-Covid versus post-Covid was 30,000 versus 25,000, effectively a loss of 16.6% in the family income. Adverse impacts on health and economic conditions were observed in 31.3% and 20.7%, respectively.

Conclusion: Post-Covid clinics can be a resource-appropriate health system approach for nearly 20% of the pandemic survivors with a low gross domestic product (GDP) per capita.


7.          Bari, M., Konchada, S., Pradhan, S., Gulia, A., Sandeep, B., Goyal, D., Kaushik, S., & Dhingra, K. (2022). Management of Scaphoid Nonunion (SNU) With Ilizarov Ring Fixator Using Two Olive Wire Compression Without Bone Grafting: A Case Series. Cureus, 14(11), e31646. https://doi.org/10.7759/cureus.31646

Abstract

Background: The scaphoid is the most commonly fractured bone among the carpal bones seen in orthopedic practice. The majority have good favorable prognosis, but some develop nonunion of fracture despite optimal treatment, which can lead to further complications if left untreated. It is recommended that displaced scaphoid nonunions (SNUs) should be reduced and fixed to prevent degenerative changes from occurring, even if they are asymptomatic. Many treatments have been described, from a percutaneous fixation with a k-wire or screw to open reduction and internal fixation with or without bone grafting, but none of them is the gold standard. Aim: To evaluate the outcome of an SNU treated with an Ilizarov fixator usin two olive wires without bone graft. Methods: Eleven cases of non-union scaphoid fractures were considered in the study which was presented to the Department of Orthopedics of Kalinga Institute of Medical Sciences during the period of March 2015 to March 2018. This study has been approved by the scientific and ethical committees. The anatomical location of the fracture was graded according to the MAYO classification. An Ilizarov frame was applied with two cross olive wires for achieving compression at the fracture area and maintained for six weeks. A final outcome was assessed using the scaphoid outcome score.

Results: One out of 11 patients operated on during the study period was lost in follow-up, s 10 patients were considered for analysis of the results. There were nine male patients and one female patient. The majority were right-sided and dominant-handed, with varied occupations. The average duration of nonunion, when presented, was 10.7 months (a range of 6-20 months). The average follow-up was 43.6 months (range 27-60 months). Union was achieved in an average of 12.9 weeks (range 10-18 weeks). All the patients returned to their pre-injury activity level in a mean of 17.1 weeks (range 13-23 weeks). Grip strength improved from a mean of 29.5 kg preoperatively to 39.4 kg postoperatively. At the final follow-up,

the mean scaphoid outcome score was 9.1. An excellent outcome was obtained in five cases (50%), a good outcome in three cases (30%), a fair outcome in one case (10%), and in one case (10%), a poor outcome. Conclusion: With our technique of Ilizarov fixation and compression with two cross olive wires, SNU can be treated safely even without opening the non-union site and even without bone grafting. Since we excluded SNU patients with humpback deformity, carpal instability, carpal collapse, or avascular necrosis (AVN), our

results might not be directly comparable to those of other SNU series in the literature. These would have predisposed to a poor outcome. Since we did not assign the patients at random, it is challenging to compare the Ilizarov technique to other widely used SNU treatments and determine whether it is more effective. However, the study’s results are encouraging and show that the Ilizarov method using two olive wires for compression.


8.          Singh, N., Mohapatra, I., Singh, S., Srivastava, V., & Mishra, K. (2022). Perceived Barriers in Delivering Optimal Healthcare Services in a Dedicated COVID-19 Hospital: Perspectives of Health-Service Providers. Cureus, 14(10), e30188. https://doi.org/10.7759/cureus.30188

Abstract

Background:

The coronavirus disease 2019 (COVID-19) pandemic challenged the healthcare infrastructure, with health service providers (HSPs) offering unconditional and unprejudiced service to admitted patients. During the first wave, due to the novelty of the disease and the lack of clarity regarding its transmission in the initial phases of the evolution of the disease, the predominant fear was of contracting the disease while caring for patients. With the prevailing uncertainty in knowledge and management, this study was planned to identify the barriers to delivering optimal healthcare to COVID-19 patients.

Methodology:

A cross-sectional study was conducted among HSPs working in the first phase of a dedicated 500-bed government COVID-19 hospital at Kalinga Institute of Medical Sciences using an online questionnaire with the following five aspects: workplace guidelines and support, protective equipment, access to information regarding updates on the epidemic, overall self-reported stress and workplace stress about self-infection with COVID-19 and family being infected, and demographics. All HSPs aged 18 years or above, who were working either on a full- or a part-time basis, were able to understand the English language, and who were working in the COVID-19 hospital and gave digital informed consent (via Google Forms) were included in the study. All data were collected, coded, tabulated, and analyzed using Google Forms in an Excel format and Epi Info software version 7.2.5.0.

Results:

Of the 144 respondents contacted, 132 completed the survey, with a participation rate of 91.67%. About 52.27% of respondents were aged 21-30 years, 68.18% were females, and 56.06% were nurses. Challenges faced were “working in a new context” (40.91%), “the uncertainty and fear of being infected and infecting others” (31.06%), and “exhausted by the workload and protective gear” (18.94%). Moreover, 64.12% were aware of a workplace policy. Only 0.75% felt that their workload needed to be reduced; 2.27% felt the need for a penalty policy for hiding travel history, lack of quarantine compliance, avoiding the accumulation of face masks, and price inflation of face masks. The overall self-reported stress level was significantly associated with a lack of awareness of workplace policies and the fear of getting infected. Furthermore, 93.94% reported that they had an adequate supply of personal protective equipment. As high as 81.06% of the HSPs were “worried about being infected from COVID-19 during work,” and 94.69% were “worried about their family being infected from COVID-19 due to their working in COVID-19 hospitals.”

Conclusions:

HSPs’ perception of barriers in providing healthcare gave an insight into the problems being faced and helped improve the quality of services. The study highlighted the need of increasing awareness regarding the existing workplace policies among HSPs to promote preparedness during crisis management.


9.          Mehta, P., Ahmed, S., Shenoy, P., Skaria, T. G., & Paul, A. (2022). Withholding methotrexate after COVID-19 vaccination: different strategies, same results? – Author’s reply. The Lancet. Rheumatology, 4(12), e817–e818. https://doi.org/10.1016/S2665-9913(22)00335-6

Abstract

De Medeiros-Ribeiro and colleagues suggest that this absence of screening for anti-RBD antibodies would lead to inclusion of more patients in MIVAC II with possible hybrid immunity who would have shown increased immunogenicity post vaccination. However, we have taken all other possible measures to exclude patients with past SARS-CoV-2 infection, including exclusion of known COVID-19 and nasopharyngeal RT-PCR-positive cases, individuals with symptoms of COVID-19 or acute febrile illness 6 months before random assignment, and primary contacts of SARS-CoV-2-positive cases, as well as screening for anti-nucleocapsid antibodies. Thus, it is theoretically correct that there might be individuals who have hybrid immunity in MIVAC II, but on a practical level, this number should have been mitigated by such stringent screening. Another reason patients are unlikely to have hybrid immunity is the relatively low antibody titres after the first dose of vaccine in all patients in the MIVAC trials. We had shown previously that patients with previous SARS-CoV-2 infection develop very high antibody titres (>5000 IU/mL) after a single dose of vaccine; we found this to be the case even in patients on immunosuppression. We have re-examined our data and identified 13 individuals who had antibody titres above 500 IU/mL, who were equally distributed between the two trials (six from MIVAC I, and seven from MIVAC II; p=0·6). The level of antibodies after the second dose in the methotrexate continuation groups of MIVAC I and II were similar. If there were significant number of people with previous SARS-CoV-2 infection in MIVAC II, this would have been expected to lead to higher levels of antibodies in the methotrexate continuation group of MIVAC II when compared with the same in MIVAC I.


10.       Giri, S. K., Mohapatra, P. S., Senapati, L. K., & Mishra, K. (2022). A Comparison of Hemodynamic Changes Between the Use of Etomidate and Propofol as Induction Agents for Anesthesia in Daycare Surgeries. Cureus, 14(12), e32421. https://doi.org/10.7759/cureus.32421

Abstract

Background and objective:

The development of modern anesthetic agents has made it possible to conduct pain-free surgical procedures. The role of the anesthetist in choosing a suitable anesthetic agent to provide a good anesthetic and sedative effect is very important in any surgical procedure. There is always a degree of risk involved as the hemodynamic parameters may be altered. This study aimed to compare the hemodynamic changes and respiratory effects between the use of etomidate and propofol for the induction of general anesthesia (GA) as well as to compare the side effects of both drugs in daycare surgeries.

Methods:

The study was a parallel-design, randomized, double-blinded control trial conducted over a period of three years among patients undergoing elective daycare surgeries under GA. The patients were classified into two groups depending on the type of drug received: Group A or the propofol group and Group B or the etomidate group. Randomization was done by computer-generated random number generator software. A total of 174 patients were selected (87 in each group) at a ratio of 1:1. A baseline evaluation of the hemodynamic parameters was done followed by continuous monitoring.

Results:

 The age, weight, and gender distribution of the patients in both groups were comparable. Significant hemodynamic changes were observed following induction in Group A. The fall in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MABP) in Group A following induction was found to be statistically significant.


11.       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 stays and direct antibiotic pressure in the hospital can lead to the development of CLR variants.


12.       Mohakud, N. K., Panda, R. K., Patra, S. D., Sahu, B. R., Ghosh, M., Kushwaha, G. S., Misra, N., & Suar, M. (2022). Genome analysis and virulence gene expression profile of a multi drug resistant Salmonella enterica serovar Typhimurium ms202. Gut pathogens, 14(1), 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 subsp 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.


13.       Dey, J., Mahapatra, S. R., Raj, T. K., Kaur, T., Jain, P., Tiwari, A., Patro, S., Misra, N., & Suar, M. (2022). Designing a novel multi-epitope vaccine to evoke a robust immune response against pathogenic multidrug-resistant Enterococcus faecium bacterium. Gut pathogens, 14(1), 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 immunoinformatics 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 immunoinformatics 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.


14.       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. doi: 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.


15.       Das, P. K., 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. Journal of Pharmacy and Bioallied Sciences, 14(5), 568. 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.


16.       Premkumar, M., & Anand, A. C. (2022). Overview of Complications in Cirrhosis. Journal of clinical and experimental hepatology, 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.


17.       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, 44(5), 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.

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