Context: India accounts for 27.3% of total neonatal deaths in the world. This rate is highest in poor and marginalized areas like hilly regions of Uttarakhand that lack medical facilities. The newborns referred from here and admitted as outborn neonates contribute to the high neonatal mortality rate (NMR) of India. Aims : To study the demographic profile and morbidity-mortality pattern of neonates admitted in Sick Neonatal Care Unit (SNCU) and study the difference between inborn and outborn neonates. Study Design: Retrospective study of medical records for 1 year (2013-2014). Subjects and Methods: The age, sex, gestational age, and morbidity and mortality profile of all SNCU admissions in 1 year was determined, and the difference between inborn (those born in Teaching Hospital) and outborn (neonates delivered outside and referred) was calculated. Modifiable risk factors to reduce NMR in Uttarakhand were determined. Statistics: The data were analyzed using appropriate statistical tools in software Statistical Package for the Social Sciences (SPSS)-18. Results : Of the 721 neonates admitted, 63.25% neonates were males, and 53.54% were outborn and 46.46% inborn. Approximately, 60% were low birth weight and 50% preterm. Respiratory distress syndrome (RDS) (21.9%), sepsis (19%), perinatal asphyxia (16.37%), and jaundice (12.9%) were the chief morbidities. The chief causes of mortality were prematurity (25.6%), sepsis (21.6%), perinatal asphyxia (19.5%), and RDS (17.3%) with a statistically higher rate in the outborn in comparison with inborn. Total 20.5% neonates died due to poor outcome of outborn neonates. Conclusion: Huge burden of neonatal death among the outborn is due to preventable causes like asphyxia and infections in Uttarakhand. Health policies must ensure increased access to essential services to target sick neonates born here.

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Background: Interventions involving the middle meatus are commonly performed because the majority of the paranasal sinuses open into the osteomeatal complex. Therefore, the aim of the present study was to locate the level of maxillary sinus ostium (MSO), to measure the distances between MSO and different anatomical landmarks, to measure the different dimensions of maxillary sinus and to compare the morphology of maxillary sinus between the right and the left sides. Materials and Methods: The study involved 50 computed tomography (CT) images of normal paranasal sinus anatomy in coronal and sagittal planes from the Department of Radiodiagnosis. The location of the sinus ostium (upper, middle, or lower third) was observed. Perpendicular distance from the sinus ostium to the lower border of inferior turbinate and hard palate were measured. The maximum vertical, transverse, and antero-posterior diameters of the maxillary sinus were measured. Results: Of 50 CT images, the MSO was located in the upper third in 40 cases while in 10 it was located in the middle third. The most common location of MSO was in the upper third. The dimensions of the maxillary sinus indicated bilateral symmetry. Conclusion: The dimensions of the maxillary sinus indicated bilateral symmetry, and there were no significant gender differences when compared. However, the distances of the MSO from the major anatomical landmarks were significantly different between males and females which are seldom reported earlier. This knowledge about the variations in the lateral wall of the nasal cavity is crucial during the endoscopic interventions and for functional endoscopic sinus surgeries.

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Aims and Objectives: 1 To study the prevalence of hypertension in Type-2 diabetic patients. 2 To study the association with hypertension and diabetic complications. Materials and Methods: A total of 250 diabetic patients coming to Vijayanagara Institute of Medical Sciences Hospital and College, Bellary were studied and evaluated for blood pressure (BP), and macrovascular and microvascular complication. Study Design: A cross-sectional study. Sample Size: 250. Inclusion Criteria: All Type-2 diabetic patients who are on treatment for diabetes. Exclusion Criteria: a. Newly diagnosed diabetes, b. Seriously ill patients, c. Refused to be a part of the study, d. Pregnancy, e. Type-1 diabetes mellitus. Results and Conclusion: Prevalence of hypertension noted in 64 (25.6%) patients. BP was normal in 55 (22%), 131 (52.4%) patients were prehypertensive, 45 (18%) patients were in stage-1 hypertension, and 19 (7.6%) had stage-2 hypertension. Macrovascular complications noted in 120 (48%) and microvascular complications noted in 60 (24%) patients.

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Tuberculosis (TB) is still among the most life-threatening infectious diseases, resulting in high mortality in adults. A significant proportion of patients (15-25%) exist in whom the active TB infection is manifested in an extrapulmonary site. Healthcare workers, including dentists, are at the frontline and can make an important contribution to the control of this infectious epidemic. Oral TB has been considered to account for 0.1-5% of all TB infections. Nowadays, oral manifestations of TB are re-appearing alongside many forgotten extrapulmonary infections as a consequence of the outbreak and emergence of drug-resistant TB and of the emergence of acquired immune-deficiency syndrome.

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Introduction: Cerebral palsy (CP) is emerging as one of the main causes of childhood disability in India. Care provided to children with disability largely depends on the awareness, beliefs, and socioeconomic status of the community. This study examines the influence of awareness, beliefs, concerns, and socioeconomic status of the families having children with cerebral palsy in Jalandhar District as one of the cities of state Punjab, Northern India, on the service utilization pattern. Materials and Methods: The study has been approved by BPSAR, Punjabi university, Patiala. Personal interview of 248 families of the children with cerebral palsy using semi structured questionnaire has been the tool for data collection. Results: The awareness of key legislative acts on disability has been nil, though 16.1% parents know about Right to Education (RTE) act and have some knowledge of disability certificate, travelling concession, and benefits and tax rebates available to parents of children with disability. Close to 70% families believe that the condition of the child is so because of the deeds of parents in their previous life and almost an equal number accuse the mother for present condition of her child. Care of child after the demise of parents and the scattered facilities of rehabilitation were the main concerns. Massage has been the most common service utilized by 57.6% followed by physiotherapy (55.6%) and orthoses (38.70%). Speech therapy and special education has been utilized for just 4% of the children belonging to upper and middle classes only and none of the children of any class has received occupational therapy. Conclusion: The awareness level and pattern of service utilization was significantly (P < 0.05) associated with the socio-economical status of family and awareness of rehab services requirements. The findings of the study reinforce that it is essential that concrete steps should be taken to sensitize the community and medical professionals about the needs and methods of rehabilitation of cerebral palsy.

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Introduction: Brucellosis is a zoonotic disease of public health importance having an impact on animal husbandry and dairy industry. Isolation of bacteria from blood cultures is very low, and diagnosis mainly depends on serology and molecular methods. The aim of this study is to know the impact of various serological tests on the diagnosis of brucellosis. Materials and Methods: In a prospective study, a total of 180 samples, 90 from pyrexia of unknown origin (PUO) and 90 from high-risk group comprising veterinarians and animal handlers were serologically tested by Rose Bengal plate test, standard tube agglutination (STA) test and enzyme-linked immunosorbent assay (ELISA) and results were analyzed. Results: Out of 90 PUO cases, 28 were positive for brucellosis and in high-risk group, out of 30 veterinarians three were positive and out of 60 animal handlers 14 were positive. Male preponderance was seen. Rose Bengal and STA tests were still efficient methods for brucellosis serodiagnosis. The ELISA was observed to be more efficient in both acute and chronic brucellosis. Conclusion: All the three methods used are efficient methods for detecting Brucella antibody. Rose Bengal card test is the best suited for rapid diagnosis in rural endemic area as STA test is laborious and time-consuming. ELISA is the most sensitive test.

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Context: Diagnostic services have a very important role to play in medical decision-making, which have an impact on the nation's health status. The understanding of Indian diagnostic services provisioning has certain literature gaps. Aims: This study focused on understanding the functioning of provision of diagnostic services by Indian diagnostic laboratories. Materials and Methods: Exploratory field visits and literature review were used as tools to understand the Indian health system. Results: Indian diagnostic laboratory can be classified into various categories based on the type of services provided and governance. The difference in their financing, resources, quality assurance of services and patient access to services was found in these different laboratories. Conclusions: It was concluded from the study that patient's access to laboratory services is affected by the functioning of laboratories in terms of governance, financing, resources, quality assurance of services and patient services.

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Introduction: Discharge time, a crucial quality indicator, is dependent on several other factors like clearance time and patient-related issues. The present study analyzes these determinants and presents measures to control the discharge time. Materials and Methods: This cross-sectional study was conducted during May-June 2013 at a large multispecialty hospital. During initial 15 days, that is, the pilot study, data was collected across various steps where time was consumed during discharge process and initiatives were taken to increase the number of planned discharges. For the main study, discharges were classified as planned/unplanned and patients as insured and uninsured. Results of pilot study and main study were compared. We computed one-sample t-test on overall discharge time, clearance time, and independent sample t-test on discharge time consumed for types of discharges. All results with P < 0.05 were considered statistically significant. Results: Out of 105 discharges, 75 were included wherein mean discharge time of 177.6 (± 613) min was significantly lower than the mean time of 285.42 (±105.46) min taken for 35 discharges during pilot study (P < 0.01). Mean discharge time of 572 (±1378.4) min for the 14 insured patients was significantly higher (P < 0.0001) than the 61 uninsured patients where discharge time was 88 (±84.7) min. Mean discharge time for planned discharges (n = 18) was 85 (±87.9) min that was significantly lower than unplanned discharges (n = 57) with a mean of 524 (±1446.6) min (P < 0.01). ther patient-related factors like, delay in bill payment, request for discounts further increased the discharge time. Conclusion: Planning the discharges reduced the total time of discharge process substantially. Discharge time was substantially high for insured patients that need to be controlled. Departmental clearance and patient-related factors also impact the discharge time.

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Introduction: Urinary tract infection (UTI) continues to be the most common infection diagnosed in outpatients as well as in hospitalized patients. Citrobacter spp. is an emerging urinary pathogen. The present study assessed the prevalence and antibiotic sensitivity pattern of Citrobacter spp. in patients admitted to or attending outpatient departments with Complain of UTI in a tertiary care hospital. Materials and Methods: A total of 36,250 urine samples were included in the study. UTI was confirmed in 7099 samples. Of these 246 (3.46%) had UTI due to Citrobacter spp. Identification was by conventional biochemical methods. Antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion method as recommended by Clinical and Laboratory Standards Institute M2-A9. Multidrug-resistant (MDR) was defined as resistance to more than two groups of drugs. Extended spectrum beta-lactamase (ESBL), AmpC, and metallo beta-lactamase (MBL) were detected by phenotypic methods. Results: Females predominated in the study 193 (78.4%) with 53 (21.5%) males. Most of the isolates were in the age group 21-30 and 31-40. 49 (19.9%) patients were inpatients, and 197 (80.08%) were outpatients. Aminoglycosides had a better spectrum of antimicrobial sensitivity (70.2%) with 85.2% isolates sensitive to amikacin. Fluoroquinolones had a poor activity against Citrobacter (46% sensitive). Ureidopenicillins had poor efficacy (15.4%). Out of the 246 strains, 129 (52.4%) were MDR, 61 (24.7%) of which were ESBL producers and 65 (26.4%) were AmpC producers. Most of the ESBL producing strains were isolated from inpatients. No MBL were identified in this study. Conclusion: Citrobacter though not uncommon isolate is posing a problem due to its MDR character. Infection control practices should be observed strictly, and any type of unnecessary instrumentation should be avoided.

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Sertoli cell-only syndrome (SCOS) is not an uncommon finding in testicular biopsies that are performed in patients with infertility. The salient histopathologic feature of SCOS is the absence of germ cells. Many of these patients have a normal karyotype and normal secondary male sexual characteristics, yet are infertile and azoospermic or severe oligozoospermic. This case report describes a 29-year-old male patient who presented with primary infertility, normal physical characteristics and hormonal profile with SCOS detected on testicular biopsy.

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Dengue hemorrhagic fever (DHF) and Dengue shock syndrome manifest in various forms, ranging from petechial skin hemorrhage to life threatening cerebral, pulmonary, gastrointestinal and genitourinary hemorrhages. However it is very rare to have muscle hematomas in DHF. We report a rare case of spontaneous Iliopsoas hematoma complicating Dengue hemorrhagic fever.

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Background: Bloodstream infections (BSIs) are one of the serious infections causing significant morbidity and mortality among hospitalized patients. Large numbers of cases of treatment failure are being reported due to emergence of drug resistance. Early microbiological diagnosis and determination of antimicrobial susceptibility pattern have been shown to improve treatment outcome. The present study was aimed to determine the bacterial and antimicrobial resistance profile of BSIs in a major tertiary care hospital. Materials and Methods: Blood samples in brain heart infusion (BHI) broth submitted to the microbiology laboratory for culture and sensitivity during a period of 1 year were included in the study. Samples were processed as per standard protocol of laboratory for isolation and identification. The antimicrobial susceptibility profile of bacterial isolates was determined by the disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Out of 4862 blood samples, 494 (10.16%) isolates were obtained. Of these isolates, 256 (51.82%) were Gram-negative and 230 (46.56%) were Gram-positive bacteria. The most commonly identified organism was coagulase-negative Staphylococcus (CoNS) (25.91%) followed by Acinetobacter spp. (20.24%) and Escherichia coli (14.98%). Gram-negative bacteria showed a higher rate of resistance as compared with Gram-positive bacteria. Conclusion: High prevalence of antimicrobial resistance was noted in this study, especially in Gram-negative bacteria. Hence, appropriate treatment of BSIs should be based on the current knowledge of bacterial resistance profile as provided by microbiology laboratory. It would be advisable for the clinicians to mandate antimicrobial sensitivity testing for suspected cases of BSIs.

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Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint associated with considerable morbidity and significantly affects the patient's family, personal and social life. The aim of the study was to analyze the histomorphological patterns of endometrium in patients presenting with AUB and also to determine the incidence of AUB in various age groups. Materials and Methods: This is a prospective study, conducted in the Department of Pathology, in a tertiary care teaching hospital, Mangalore from October 2011 till date. All cases of AUB with a probable endometrial cause were included in the study. Data was entered in Microsoft Excel and managed in Statistical Package for the Social Sciences (SPSS) version 16. Analysis was done in the form of percentages and proportions and represented as tables where necessary. Results: A total of 156 cases were analyzed. Patients' age ranged from 23-78 years. AUB was most prevalent in the perimenopausal age group. The most common presenting complaint was menorrhagia (47%). Endometrial hyperplasia was the most common histopathological finding and was seen in 25% patients, followed by secretory endometrium in 16.7% patients, and proliferative phase pattern and disordered proliferative endometrium were seen in 12.2% patients each. Malignancy was detected in 6.4% of cases and endometrial carcinoma was the most common lesion (4.5%). Conclusions: Histopathological evaluation of endometrial samples is especially indicated in women over the age of 35 years to rule out malignancy and preneoplasia. Among the patients with no organic pathology, normal physiological patterns with proliferative, secretory, and menstrual changes were observed. The most common endometrial pathology in this series was endometrial hyperplasia.

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Aim: Limited information is available on the status of mental distress among chronic disease subjects attending primary care settings in India. This study aimed to assess the pattern of mental distress among chronic disease subjects. Materials and Methods: This facility based cross-sectional study was carried out among chronic disease subjects attending urban health center attached to a Medical Institution in Puducherry, India. Mental distress was assessed by general health questionnaire-12. Data on associated factors were collected by structured questionnaire. Results: Mean age of the subjects was 58.2 ΁ 12.8 years. Around 80% of the subjects found to have mental distress. Mental distress was comparatively more among females, educated more than middle school, person living in the nuclear family and suffering from joint pain (P < 0.05). Subjects who had both diabetes and hypertension reported more mental distress. Females had comparatively more mental distress after adjusting for potential confounders. Conclusion: Mental distress among chronic disease subjects in this setting is high especially among females screening of this high-risk group may help in taking appropriate interventional measures.

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Introduction: Medical education is highly challenging and often places heavy demands on the mental health of the students. Stress is an external constraint which upsets an individual both mentally and physically. The postgraduate students suffer from higher stress that definitely affects the mental wellbeing of these students. Study Design: It is a cross-sectional, observational study. Objectives: The objective of the present study was to explore the level of stress, anxiety and depression among the postgraduate medical students. The secondary objective was to find out the factors affecting the stress, anxiety and depression level in these students. Materials and Methods: Fifty post graduate medical students of Government Medical College were selected. Depression, anxiety and stress scale 42 questionnaires were given for assessment of stress level. A completed scale was taken for assessment from the students. Result: The mean depression score was 6.26 ± 6.00, the anxiety score was 10.34 ± 3.91 and the mean stress score was 15.30 ± 3.93. The present study showed mild anxiety level and moderate level of stress in postgraduate students. The study showed a difference in stress level when compared for age and gender, but it was not statistically significant. When the stress level was compared for clinical and non-clinical departments; the difference was statistically significant. Conclusion: The present study concluded that a high level of stress is seen in postgraduate medical students. The study further concluded that there are various factors which can affect the level of stress. These factors should be assessed separately for the further study.

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Objectives: The aim of this study was to assess the drug use pattern using World Health Organization (WHO) prescribing, patient care and health facility indicators at Secondary Care Referral Hospital of South India. Methods: A cross-sectional study was conducted at Secondary Care Referral Hospital of South India. WHO core drug use indicators questionnaire was used for the assessment of drug use pattern which comprise of five prescribing care indicators, five patient care indicators and two health facility indicators. 603 patient encounters were reviewed prospectively for a 6 months period from November 2013 to April 2014. Data were collected from outpatients of the pharmacy and results were represented in descriptive statistics. Results and Discussion: The average number of drugs prescribed per prescription was 2.7. The percentage of prescriptions in which antibiotics and injections were comprised about 9.6% (n = 159) and 1.6% (n = 27), respectively. The percentage of drugs prescribed by generic and from essential drug list (EDL) was 42.9% (n = 709), and 95.6% (n = 1578), respectively. The average consulting and dispensing time was 3.7 min and 2.3 min, percentage of drugs actually dispensed and adequately labeled was 96.6% and 99.3%. Percentage of patients had knowledge of correct dosage was 89.3%. The copy of EDL was available and the percentage of key drugs available was 88%. Conclusion: On the basis of above findings, the study was concluded that the prescribing indicators were met WHO standard criteria. The patient care and health facility indicators are rational and the importance of these indicators was encouraged by the doctors and the pharmacists. It shows that available drugs are satisfying unlimited healthcare needs of the public. Further, such studies at different regions of India and their review may produce beneficial results for the betterment of the society.

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Background and Objectives: Cervical cancer is a leading cause of cancer mortality among women in India. Hence, the objectives of this study were to find out the perception of women towards cervical cancer and assess their health-seeking behavior for screening. Methodology: A cross-sectional study was conducted from November to December 2009 among married women above 15 years of age by systematic random sampling of households in Field Ganj, Ludhiana, India. Information was gathered by a questionnaire assessing the knowledge, attitude, and practices regarding cervical cancer. Results: Of the 304 women interviewed, 28.9% (88) had heard of cervical cancer and 12.2% (37) knew it could be preventable. Only 4.3% (13) of the women had heard about Pap smear. Interpretation and Conclusions: Inadequate knowledge about cervical cancer and Pap smear is the greatest obstacle to effective screening. Identifying individual and community-level barriers is important in increasing cervical cancer screening.

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Background: Irrational usage of antibiotics increases the risk for the antimicrobial resistance, leads to increase morbidity, mortality, and economic burden for health care. India is a lower-middle income developing country in south Asia that has high potential for overuse and misuse of antibiotics and has less public awareness of antimicrobial resistance. The World Health Organization (WHO) developed the prescribing indicators to measure the rational usage of drugs in primary care and to assess the prescribing pattern of antibiotics. Aim: The aim of the study was to assess the prescribing pattern of antibiotics in pediatric patients of Anantapur district, Andhra Pradesh, India. Subjects and Methods: A cross-sectional and prospective study was carried out in private pediatric specialty hospitals in urban areas of Anantapur district. Sample size was calculated using single population proportion formula. A total number of 845 pediatric in-patients were included for the study. Patients' demographic characters, diagnosis, and drugs prescribed were recorded in a prestructured and validated data collection form. Results: An average of 3.53 drugs prescribed per patient encounter, which was higher than WHO prescribed indicator standard value 2. The present study reveals that the percentage of encounters with antibiotics was 50.05% (423), which was higher than WHO standard (20.0-26.8%). Among 423 antibiotic prescriptions, 23.43% (198) prescribed with generic names and 91.48% antibiotics were prescribed from essential drug formulary list. Conclusion: Prescription patterns and usage of antibiotics in this study was inappropriate in comparing our results with WHO prescribing indicators. Effective interventions are required to reduce inappropriate antibiotic prescriptions.

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Violence against doctors is on the rise worldwide. Doctors are no more considered demigods or authorities in their field; on the one hand, where there is a valid reason for it because of the dilution in the field; however, on the other hand, the distrust is getting generalized to the whole community of physicians. Violence against them in any form is reprehensible. However, acts of violence in a hospital are the most extreme and should be dealt with an iron hand.

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This manuscript reviews and describe the burden of cervical cancer in world and India, epidemiology of HPV infection, screening methods, prevention, control strategy, types of HPV vaccines, schedule, age of administration, dose, route, anatomical site of human papillomavirus vaccination, cold chain, vaccine coverage and roll out plan in Delhi, India.

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Background: Transfusion-transmissible infections HIV, HBV, and HCV are among the greatest threats to blood safety for transfusion recipients. Seroprevalence among blood donors is a useful source of information on their prevalence in the community. The present study was undertaken to determine the profile of the seropositive blood donors attending the blood bank at Christian Medical College, Ludhiana, Punjab. Materials and Methods: This was a 3-year cross-sectional study, (1 ^st January 2008 till 31 ^st December 2010) whereby the data of the blood donors screened during this time were analyzed. We further studied the epidemiological profile of the seropositive donors. Results: There were a total of 32,829 donations. Seroprevalence of HIV, HBV, and HCV were 0.27%, 1.11% and 1.53%, respectively. Most of them were males (96.76%) and were in the age group of 18-30 years. Replacement donors constituted 95.75%. Occupation of seropositive donors included business, various services, and agriculture. There were 89 students who were seropositive. Conclusions: Seroprevalence among blood donors has shown a significant (P value for HIV 0.05, HBV < 0.001, HCV 0.004) decreasing trend over the 3 years. The professional distribution reveals the shift in seroprevalence from the high-risk group to the general population. Introducing pre test and post test counselling in blood banks will identify patients at an earlier stage where treatment would be more effective. The need to shift the burden to voluntary blood donation cannot be overemphasised.

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Background: End stage renal disease (ESRD) patients on maintenance hemodialysis undergo arterio-venous fistula (AVF) cannulation prior to each hemodialysis session for blood access. Prior to cannulation lidocaine infiltration is done, which is often perceived as painful. Eutectic mixture of local anesthetic (EMLA) has been found to significantly reduce pain associated with radial artery cannulation compared with lidocaine infiltration. Aims: To evaluate the efficacy of EMLA compared to infiltration of lidocaine in hemodialysis patients for AVF cannulation. Materials and Methods: A single-centre, crossover study of patients with an AVF on regular maintenance hemodialysis was performed in the dialysis unit of a tertiary care teaching hospital. The site of AVF, number of attempts for AVF cannulation and cannula insertion time were recorded. The patients were asked about the acceptability of application of the anesthetic, delay between anesthetic and cannulation and to score the pain on cannulation. Results: Fifty patients were included in the study. With the visual analog scale, pain score on infiltration was 4.8. Pain score on cannulation after topical application was 2.9 and after infiltration, 2.0. The number of attempts for cannulation and the cannula insertion time were similar. Anesthesia was more stressful in the injectable group rather than the topical group (P < 0.001). Delay between anesthetic and cannulation was unacceptable in the topical group (P < 0.001). Patient compliance was better during infiltration compared to topical (P < 0.005). Mean pain score during infiltration of anesthetic was significantly higher than cannulation pain after either anesthetic, although pain on cannulation was higher in the topical group (P < 0.001). Conclusions: EMLA offers a suitable alternative to lidocaine infiltration for patients using AVF for blood access.

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Context: Micronucleus (MN) has been proved to be an important biomarker of genomic damage. MN scoring in oral exfoliated epithelial cells has been used in the past as a biomarker to identify different preneoplastic conditions much earlier than the manifestations of clinical features. However, no attention has been, until now, given to determine the overall accuracy of MN assay in diagnosing potentially malignant disorders (PMDs). Aim: The present study was being conducted to evaluate the diagnostic accuracy of MN assay in PMDs of oral cavity. Materials and Methods: Cytosmears from 30 controls with healthy mucosa and 45 cases as patients with suspicious lesions, clinically diagnosed as PMDs of the oral cavity were taken and separately stained with Papanicolaou (Pap) stain and haematoxylin and eosin (H and E) stain. MN frequency was evaluated and based on the 50 ^th percentile of all the MN (%) frequency values obtained for both the groups combined; a cut off value was calculated independently for each stain. Results: The sensitivity and specificity with Pap stain was found to be 84% and 93%, respectively, with diagnostic accuracy of 88%, whereas with H and E stain, sensitivity of 89% and specificity of 100% with diagnostic accuracy of 93% was observed. Conclusion: MN assay in oral exfoliated epithelial cells can be conveniently used as a biomarker for the screening of PMDs of oral cavity.

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Background: Shigella is an important cause of invasive dysentery in children and others. The present study was done to study the prevalence, any seasonal variation, distribution among children and adults, and antimicrobial susceptibility pattern of Shigella isolates in stool. Materials and Methods: A retrospective study was conducted over a period of 1 year from June 2011 to June 2012 in the department of microbiology, in a tertiary care hospital in Punjab. Stool specimens from diarrhea/dysentery cases in different age-groups were processed. The specimens were processed by standard microbiological techniques. The suspected colonies of Shigella were identified by standard biochemical tests and serotyping was done by group specific antisera. The susceptibility of all the isolated Shigella species to different antibiotics were done by Kirby-Bauer's disk diffusion technique as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Shigella species were isolated from 30 (2.1%) of the total 1,402 stool samples received during the study period. Among these, Shigella flexneri was the predominant species accounting for 57% of isolates, followed by S. sonnei (36%) and S. boydii (7%). Over 70% of Shigella isolates were resistant to two or more drugs including ampicillin, trimethoprim-sulfamethoxazole, and norfloxacin; and 10% Shigella isolates were resistant to chloramphenicol and ceftriaxone during the study period. No resistance was observed to cefoperazone/sulbactam, piperacillin/tazobactam, and imipenem. Conclusions: The results of the study revealed the high prevalence of shigellosis with S. flexneri as the predominant species. The result also suggests that ampicillin, trimethoprim-sulfamethoxazole and norfloxacin should not be used empirically as the first line drugs in the treatment of shigellosis. Periodic analysis and reporting of antibiotic susceptibility is an important measure to check for antibiotic resistance and form appropriate treatment protocols.

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Introduction: Antibiotic resistance is an increasing concern worldwide, specially in Gram negative bacilli where there is a paucity of new and effective antimicrobial agents. Pseudomonas aeruginosa is inherently resistant to different antimicrobial agents who are responsible for increase in morbidity and mortalities found in all types of patients. The purpose of this study was to evaluate the antibiogram of Multi drug resistant (MDR ), Extremely drug resistance (XDR) and Pan drug resistant (PDR) Pseudomonas aeruginosa. Aims and objectives: To find out the frequency and resistance pattern of MDR, XDR and PDR Pseudomonas aeruginosa. Materials and Methods: This is six month retrospective study, conducted in department of Microbiology a tertiary care hospital and teaching institute. During the study period (July-Dec 2013) routine samples were tested to standard microbiological procedure. Isolates were identified up to species level, Pseudomonas aeruginosa were picked up for further studies. Antibiotic sensitivity testing (AST) was performed by the Kirby-Bauer disc diffusion method, Carbapenemase production was screened by Hodge test and Modified Hodge test, extended spectrum beta lactamse (ESBL) production and AmpC presence were screened by two disc method. According to the sensitivity pattern, the strain was identified as MDR, XDR and PDR Pseudomonas aeruginosa. Results: During the study Pseudomonas aeruginosa were isolated from 198 (21.85%) samples. Among 198, 12 (6.06%) were identified as PDR, 23 (11.6%) were XDR whereas 49 (24.7%) were MDR. Out of 198, 98 (49.49%) were ESBL, 40 (20.20) were Carbapenemase producer and 4 (2.02) were AmpC producer. Conclusions: Though Pseudomonas aeruginosa is inherently resistance to different antimicrobial agents, irrational and inappropriate use of antibiotics is also responsible for the development of resistance to antibiotic. Hence, there is a need to emphasize the "rational drug" to minimize the misuse of antimicrobials. To minimize morbidity and mortalities due to Pseudomonas aeruginosa infection, prior AST is essential to provide specific treatment.

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