Background and Objectives: Although tuberculosis (TB) is a notifi able disease in India, most of the cases of TB are either not recorded or reported. Among diagnosed cases, for improving reporting, proper feedback on referral outcome needs to be ensured to all health care providers who refer cases to the public health system. Materials and Methods: All the received feedbacks for TB patients referred for treatment from July 2013 to December 2013 were analyzed. Feedback reports including referral date, the age and sex of patients, type of disease, and date of treatment initiation were examined. Results: Of the total 1,259 referred TB patients during the study period, feedback was received for 54% of them. Only 42.3% (n = 532) of the referred patients were successfully linked at the treatment facility. Seven (0.6%) referred patients died before the initiation of treatment while 3.7% migrated, 2.4% gave the wrong address, 1.0% started private treatment, and 0.6% were nontraceable; in 3.2% cases only was the TB number given. Feedback was signifi cantly associated with sex, age group, type of treatment, disease type, and place of residence. Conclusion: The feedback received for referred patients was poor and for improving the care of TB patients, there is a need to strengthen the feedback mechanism in Revised National Tuberculosis Control Programme (RNTCP) for referred patients.

Background and Objectives: Hepatitis, a condition with liver inflammation, mostly follows hepatitis virus infection of different types A, B, C, D, and E. Each year, numerous outbreaks of hepatitis virus are being reported from around the country, more so from the “Empowered Action Group (EAG) States.” The present outbreak investigation was performed in Odisha, India to study the epidemiology, explore the reasons behind it, and suggest preventive measures for the future. Materials and Methods: A team consisting of public health doctors from All India Institute of Medical Science (AIIMS), Bhubaneswar, Odisha, India investigated the hepatitis E outbreak as per standard guidelines in one of the villages of Tangi block in the state of Odisha, using a questionnaire between January 1, 2015 and January 15, 2015. The data were entered and analyzed in Microsoft Excel 2007. Time, place, and person analysis were performed for all case patients. Result: Hepatitis E outbreak occurred between November 16, 2014 and January 1, 2015, affecting 22 individuals. The attack rate was 44/1,000 in the population and young males were mostly infected. Spot map of the outbreak probably points toward point source epidemic. Most of the infected cases had visited allopathic doctors as well as traditional healers. Less than 50% people had some knowledge about the prevention and control of hepatitis virus infection. Open defecation was highly prevalent in the village. The well was the commonest source of drinking water and the condition of wells was non-sanitary. Less than 2% started hand-washing after the end of the outbreak in the community. Conclusion: Focus of outbreak investigation should not restrict only to immediate control but should rather lead to intervention by the health system in the area for construction of community toilets, improved drinking water facilities, and sustained information, education, and communication (IEC) activities to promote personal hygiene and water safety behavior in the community.

Objective: To evaluate the clinical efficacy and safety of moxifloxacin injection in the treatment of acute exacerbation of chronic bronchitis (AECB) in daily clinical practice. Patients and Methods: From May 2009 to March 2011, a total of 1026 cases with AECB were collected from 43 hospitals in eight cities. All the patients were treated with moxifloxacin (400 mg qd) intravenously. Whether to use oral or sequential therapy was decided by the physicians according to the clinical efficacies. Patient conditions such as combined uses of drugs, efficacies and adverse events were recorded and analyzed. Results: The cure rate of infection was 83.03%, and the total effective rate of moxifloxacin injection was 93.80%. The efficacies were statistically different among subgroups with different ages, complications, forced expiratory volume in 1 s (FEV ₁ %), and combined uses of drugs, respectively. Multivariable logistic regression analysis showed that the advanced age (≥65 years) and severe obstructive pulmonary disease (FEV ₁ <50%) were significantly correlated with the clinical efficacies. A total of 15 cases of adverse events were recorded, and the incidence rate was 1.23%. Conclusion: Moxifloxacin injection can effectively control the infection of AECB patients with fewer adverse events.

Background and Objective: The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug-resistant TB, has become a significant public health problem globally. In spite newer modalities for diagnosis and treatment of TB, unfortunately, millions of people are still suffering and dying from the disease. The present study was aimed to study the prevalence of initial drug resistance and the treatment outcome at the end of 6 months in TB patients attending a dedicated TB outpatient department (OPD) in North India. Materials and Methods: A cross-sectional, observational study was carried out on 100 patients of newly diagnosed pulmonary TB with or without glandular involvement attending TB OPD of a tertiary care hospital over a period of 6 months. Results: Culture positivity was encountered in 82% of the cases, while 14% were smear positive though culture negative. Out of all culture positive patients, 56.1% were susceptible to all antitubercular drugs, while 43.9% were resistant to one or other antitubercular drugs (isoniazid, rifampicin, streptomycin or ethambutol). Of the 46 drug-susceptible cases, 93.48% got cured, while 2.2% defaulted and 2.2% had treatment failure. About 86.1% of the 36 initial drug resistant were cured with 2RHZE/4RH, while 5.6% (n = 2) defaulted treatment and 8.3% were treatment failures. Conclusion: Treatment outcomes of this small group of drug-resistant pulmonary TB patients treated with the standardized regimen was encouraging in this setting. Close attention needs to be paid to ensure early identification of drug-resistant cases; good laboratory methodology and quality control measures; regular supply of quality antitubercular drugs; adherence to the prescribed regimen; effective patient education and counseling; and to the timely recognition and treatment of adverse drug reactions for better treatment outcome.

Background and Aim: Foot ulcers are a significant complication of diabetes mellitus and are usually poly-microbial. Aerobic Gram-negative bacilli are isolated in higher frequency with increasing grade of ulcers, and development of drug resistance is a cause of concern. The aim of our study is to identify the extended spectrum β-lactamases (ESBL) and AmpC β-lactamases among the Gram-negative aerobic bacterial isolates in the different grades of diabetic foot ulcers. Materials and Methods: Pus samples from 104 male and female diabetic patients presenting with grade I to grade V foot ulcers were cultured according to the standard microbiological procedures and antimicrobial sensitivity performed by the Kirby-Bauer disc diffusion method as per CLSI guidelines. MIC ₅₀ of all isolates for Ceftazidime was detected by the agar dilution method. The Gram-negative bacterial isolates were further tested for ESBL and AmpC β-lactamases by the modified double disc synergy test and combined disc method. AmpC disc test was used for the confirmation of AmpC production. Results: Forty-seven isolates exhibited resistance to Ceftazidime phenotypically and 54 isolates had MIC greater than 2 μg/mL. ESBL production was observed in 55.55% of the isolates. AmpC production was seen in 19 isolates (35.18%). No mechanism of cephalosporin resistance was explainable for 5 isolates. Conclusion: The combined disc method was more sensitive in the detection of ESBLs, while the AmpC disc test was an easy way to detect AmpC beta lactamases and can be used for routine screening.

Background and Aim: Prevalence of sexually transmitted infections (STIs) shows regional variations. Various epidemiological studies report a diminishing prevalence of syphilis including other bacterial STIs and a rising incidence of viral STIs. However, a resurgence of syphilis has been observed and reported. The aim of our study was to find out the trends of syphilis among blood donors in Bastar region. Materials and Methods: This study was carried in a blood bank, attached to the Government Medical College in Bastar region, Chhattisgarh. This was a retrospective study. A total of 12,680 blood donors were screened for syphilis during 3 years (from 2011 to 2013) by Syphichik Rapid Dipstick test (Modified Treponema pallidum hemagglutination assay) and data was analyzed with respect to sero-reactive cases. Results: Out of 12,680 blood donors screened for transfusion transmitted infections, 134 donors were sero-reactive for syphilis, five donors had co-infections syphilis and hepatitis B infections, while four donors had syphilis with human immunodeficiency virus (HIV) infections. Prevalence of syphilis was more in replacement donors than voluntary donors and was in raising trend. Conclusions: Prevalence of syphilis among blood donors was in raising trends in this region and was more in replacement donors. The most common co-infections in our study were syphilis with hepatitis B infection, followed by syphilis with HIV infection. Increasing prevalence of syphilis among the donors underscores the concern about growing infection of this disease in the community as these blood donors represent the highly selective community. Proper counseling prior to blood donation, brief medical examination of blood donors and awareness about syphilis among blood donors may increase the safety of blood as well as community.

Background and Aims: There was a global influenza A pandemic in the year 2009. For this emerging infectious disease, Government of India in the year 2009 developed a training tool kit to train health care professionals for the pandemic preparedness. We present the impact of standardized training program on awareness of medical students to manage a case of influenza A (H1N1). Materials and Methods: A pre-post intervention study was designed and implemented. Before the implementation of intervention package, a baseline questionnaire was developed and administered to 179 medical students of first, second, and third semester. Training program was delivered in three batches. Each batch was given three days training. After completion of the training program, the questionnaire was re-administered. Results: The mean age of study participants was 19.2 years (SD = ΁2.3 years). Ninety-seven (45%) of the participants were female. The mean score in the pre appraisal was 6.3, which increased to 8.7 after the training component (gain index 24 %). There was a significant increase in number of medical students having "very good knowledge" (64%) and "good knowledge" (34%) after the intervention package. Conclusion: There was a significant improvement in the awareness of medical students following a training program. It is recommended that such programs should be held at regular intervals, as measure for preparedness for emerging disease outbreaks.

Background and Aims: Since 1959, treatment of infections caused by S. aureus included semi synthetic penicillin drugs such as Methicillin. Sooner a year later in 1960 Methicillin resistant S. aureus came into existence. Decade after decade the MRSA strains increased and these bacteria were marked as major cause of nosocomial infections in early 1980s. The invasion of MRSA into community is now day's matter of concern for microbiologist. This study was conducted to detect the prevalence of MRSA resistance and to prepare antibiogram of HA-MRSA and CA-MRSA isolates at our hospital. Materials and Methods: A total of 201 staphylococcus isolates were detected as MRSA. They were then separated into two categories i.e. community acquired MRSA (CA-MRSA) and hospital acquired MRSA (HA-MRSA) according prescribed criteria. Antibiogram was prepared by Kirby- Bauer disk diffusion method. Results: Out of 201 isolates, HA-MRSA prevalence was 143(28.6%) and CA-MRSA was 58(11.6%). The HA-MRSA isolates showed were 10- 30% more resistant when compared to CA-MRSA. All isolates were 100 % sensitive to Vancomycin and Linezolid. Conclusion: We strongly suggest that time to time monitoring of MRSA should be done and proper hand wash must be done to avoid spread of MRSA.

Background and Aims: Escherichia coli is the most common etiological agent in both community acquired and hospital acquired urinary tract infections. Emergence of multidrug resistance (MDR) among E. coli isolates is quite alarming. The aim of this study was to define the current prevalence of MDR and extended spectrum beta-lactamases (ESBL) production among E. coli isolates from urine samples in our hospital. Materials and Methods: Urine samples from 1225 patients were processed for wet mount followed by culture and sensitivity. All the samples were inoculated on to Hi Media Hi chrome agar plates (HiMedia Laboratories Pvt. Ltd., Mumbai, India) and growth showing significant bacteriuria (≥10 ⁵ cfu/ml) were further identified by the standard biochemical procedures and antibiotic sensitivity done as per Clinical and Laboratory Standards Institute guidelines. Detection of ESBL was done by the combined disc method. Percentage of antibiotic resistance and sensitivity and Chi-square test were used. Results: Out of 1225 samples processed, significant bacterial isolates were obtained in 357 (29.1%). The total number of E. coli isolated were 179 (50.1%) of which multidrug resistant E. coli isolates were 148 (82.6%) and 71 (39.66%) were ESBL producers. High degree of resistance was observed to amoxycillin (93.2%) and amoxycillin-clavulanic acid (90.5%). More than 80% sensitivity was seen only to imipenem (98.4%), amikacin (83.3%) and nitrofurantoin (86.6%). Conclusion: Multidrug resistant strains of E. coli are widely prevalent in the community. Antibiotics like imipenem require hospitalization, parenteral administration, drug monitoring for toxicity, all of which incur high cost to the patient and have to be used judiciously.