Introduction: Gram staining of smears prepared from positively flagged blood culture bottles plays a vital role because its accurate interpretation helps the clinicians to modify empirical therapy as well as to perform the direct susceptibility test, which reduces the turnaround time by 24 h to initiate pathogen-directed antimicrobial therapy. However, the interpretation of direct Gram stain from blood culture bottles has always been at risk of errors in interpreting. Aim: The present study was conducted to find the agreement between the blood culture broth Gram stain finding of four different methods (conventional, water wash, blood film, and drop and rest) of smear preparation with the culture smear Gram stain result and also to compare the quantity of charcoal and resin particles present in the Gram stained smears made from four different smear preparation methods. Method and Result: Smears were made from 500 positively flagged automated blood culture bottles using the four different methods and then compared for agreement with the culture smear Gram stain using kappa statistics and were found to be maximum for the blood film method (0.637), followed by drop and rest (0.570), water-wash (0.496), and conventional method (0.475). The 3+ grading for resin/charcoal was found in 184 (36.80%) smears, 169 (33.80%), 93 (18.60%), and 26 (5.20%) smears prepared by water-wash, conventional, drop and rest, and blood film method, respectively. The interference caused by resin/charcoal was maximum when smears were prepared by the conventional method resulting in high inaccurate interpretation. Conclusion: In this study, the agreement between direct smear preparation methods from positively flagged blood culture broth with the culture smear Gram stain was found to be maximum for the blood film method, followed by drop and rest, waterwash, and conventional method.It was also observed that the least amount of resin/charcoal was encountered when the direct smears were prepared using the blood film method.Hence, we found that the blood film method helps in interpreting the Gram stained smears from positively flagged blood culture broth more accurately compared to other methods.

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Probiotics are the living microorganisms that provide health benefits to the recipient. Lactobacillus and Bifidobacterium genera have been used since long for the competitive exclusion of pathogens from the gut. However, their limitations such as sensitivity to gastric acid, temperature, slow growth, and specific stability conditions lead to search for a novel probiotic that is stable through its shelf-life as well as during gastrointestinal transit; hence, offering better efficacy. Bacillus bacteria have strong scientific data which substantiates the validity of the use as preferred probiotics. In recent times, there has been significant progress in scientific evaluation and studies on probiotic Bacillus subtilis, revealing possible mechanisms of action like antimicrobial effect by synthesis of antimicrobial substances, antidiarrheal effect, immunostimulatory effect, competitive exclusion of pathogens, prevention of intestinal inflammation, and normalization of intestinal flora. Numerous preclinical and clinical studies on B. subtilis have shown its promising efficacy in the treatment and prevention of diarrhea of various etiologies. B. subtilis is certified as generally recognized as safe by Food and Drug Administration and features in the European Food Safety Authority Qualified Presumption of Safety, hence suggesting as safe for human use. All of these beneficial attributes make B. subtilis the most attractive probiotic species for various clinical conditions.

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Purpose: Studies have demonstrated the ability of Vitamin C (ascorbic acid) to inhibit pathogenic bacteria and inhibit biofilms. The effect of varying concentrations of ascorbic acid on bacterial growth was studied on uropathogenic Escherichia coli and Klebsiella pneumoniae. The concentration at which maximal inhibition occurred was determined. Methods: All uropathogenic strains of E. coli and K. pneumoniae isolated from patients over a 3-month period were incubated in varying concentrations (5, 10 and 20 mg/ml) of Vitamin C-supplemented Trypticase Soy Broth. Effect on bacterial growth was quantified as a change in absorbance measured by spectrophotometry (450 nm), as compared to controls. Independent samples t-test was used to calculate P value. Results: Bacterial growth was inhibited at all Vitamin C concentrations. Mean absorbances of E. coli and K. pneumoniae broths containing 5, 10, and 20 mg/ml Vitamin C were significantly less than absorbances of growth control broths without Vitamin C (P < 0.005). This inhibition was independent of antimicrobial resistance profiles of isolates. Differences between mean absorbance at 10 and 20 mg/ml Vitamin C for both species were not significant (P > 0.005). Thus, the inhibitory activity of Vitamin C appears to be dose-dependent, with 10 mg/ml being the optimum concentration of ascorbic acid. Conclusions: Ascorbic acid's ability to inhibit bacterial growth may find novel clinical applications. Vitamin C may find potential use in topical antibacterial applications, or urinary bladder irrigation fluid for catheterized patients with urinary tract infections or during bladder instrumentation. There is a need to further explore the possibility of using Vitamin C safely as an effective antimicrobial agent.

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Traumatic or irritation fibroma is the healed end product of the inflammatory hyperplastic lesion which can occur at any age from almost any soft-tissue site, tongue, gingiva, and buccal mucosa being the most common. The aim of this case report is to present the clinical features and management of the benign lesion which was posteriorly positioned in the interdental papillary region of mandibular premolars. A female patient, 40 years old, reported to the department with a chief complaint of pain and swelling in the right lower back tooth region for the past 1 year. On examination, the lesion was found to be a well circumscribed, smooth, tender, firm and lobulated pink swelling measuring 2 cm × 2 cm in its greatest diameter in relation to right mandibular premolar region. Surgical therapy was carried out for the management of the same. There was no recurrence reported at the end of 2 months showing that treatment with electrocautery was highly effective as it was a relatively simple and safe method with easy handling of the electrodes without any bleeding or scarring. Irritation fibroma clinically resembles as pyogenic granuloma, peripheral giant cell granuloma, or odontogenic tumors, so radiographic and histopathological examination is essential for accurate diagnosis. Furthermore, complete excision is the choice of treatment as recurrence has been associated with incomplete removal of the lesion.

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Mental health has been long neglected. Even though it causes substantial loss of disability-adjusted life years, it does not receive proportionate funding. India spends <2% of its annual health budget on mental health. India has been witnessing a great push for mental health. A number of policy-level reforms have been undertaken, and efforts are on to tackle this issue in a better way. In this study, we have reviewed various factors contributing towards policy, implementation, and utilization gaps based on published studies and Mental Health Survey reports and suggested ways to address these. Bottleneck analysis reveals that interventions to improve mental health scenario extend beyond the ambit of the National Mental Health Policy and requires strong policy negotiations and reforms to resuscitate the dying public health-care system of India.

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Background/Objectives: Herbal brews other than tea/coffee are becoming popular. We observed that these interfered with absorption of thyroxine. Since no prior studies have examined this, we sought to estimate this interaction effect, if any. Materials and Methods: This study was conducted among outpatients of a tertiary care hospital in India. Patients on thyroxine replacement were interviewed regarding the drink used with thyroxine. Various herbal brews used were compared against plain water. Thyroid-stimulating hormone was measured and compared. Results: Total of 121 patients fulfilled the inclusion and exclusion criteria, and 69 (57.0%) patients among them took thyroxine with a herbal brew. Various herbal products included cutch-tree (Karingali) 26 (37.7%), herbal mixture (Dahashamini) 28 (40.6%), and others 15 (21.7%). Risk of not achieving euthyroidism with any herbal brew was 7.6 times high (odds ratio [OR] 7·6 with 95% confidence interval [CI]: 3·1–18·5) as against plain water and was the highest for cutch, OR 12.4 with 95% CI: 4.0–38.0. Conclusions: Several patients take thyroxine with water brewed with herbal products. Effectiveness of thyroxine was greatly reduced when taken with herbal brews.

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Sinonasal imaging is performed in two major clinical scenarios: inflammatory rhinosinusitis or a suspected mass lesion. The diagnosis of rhinosinusitis is based on clinical grounds. Radiological diagnosis forms an important tool in the armamentarium to diagnose and classify rhinosinusitis. Computed tomography (CT) scan, as well as magnetic resonance imaging, may at times complement each other, to aid the clinician arrive at a diagnosis. CT scans are the gold standard study guiding management of sinusitis because they accurately depict the sinus anatomy, including soft tissue changes, anatomic variations; the osteomeatal complex, and complications, especially those involving the orbit or intracranial structures. Nevertheless, despite the best radiologic modalities, a clinicoradiological correlation is a must to accurately diagnose this often deceptive condition called rhinosinusitis.

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Progressive inflammatory periodontal disease, if left untreated, it will ultimately result in attachment loss. This can affect the bifurcation or trifurcation of multirooted teeth. Dentists are challenged to save those teeth that earlier would have been extracted without a second thought to save it. Hence, resective therapy has been utilized in the treatment of furcation defects. Hemisection is a removal of compromised root and the associated crown portion. It is one of the treatment options for preserving remaining part of molar having sound periodontium. This case report presents a patient in whom distal half of the carious and periodontally compromised tooth was resected, and after healing, fixed dental prosthesis was given to restore proper form and function.

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Background: Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss which interferes with a woman's physical, social, emotional, and/or material quality of life. This is the most distressing complication in perimenopausal women which affects the quality of life. Aims: This study aimed to evaluate endometrial thickness (ET) by ultrasound and histopathological examination and their correlation with HMB in perimenopausal women. Materials and Methods: This retrospective analysis was carried out over 1 year. A total of 120 women of 40–55 years' age group who presented with abnormal bleeding pattern were included in the study. These women underwent clinical examination, investigations and ultrasound examination followed by endometrial biopsy. Results: Majority of the women (47.5%) had menstrual disturbance in the age group of 40–45 years followed by 45.8% of women in the age group of 46–50 years. Menorrhagia was the most common complaint found in 65 (54.2%) women, 10 (8.3%) women suffered from metrorrhagia, 18 (15%) had polymenorrhea, and 22 (18.3%) women had amenorrhea followed by heavy bleeding. Proliferative endometrium was found in 90 (75%), secretory endometrium in 8 (6.7%) and simple hyperplasia without atypia in 3 (2.5%) of the women in the study population. Simple hyperplasia with atypia was observed in 2 women (1.7%), 3 women (2.5%) had complex hyperplasia without atypia, and 1 woman (0.83%) had complex hyperplasia with atypia. Endometritis was present in 5 (4.2%) cases and atrophic endometrium was found in 3 (2.5%)cases and atrophic endometrium was found in 2.5% (3). No endometrial biopsy specimen was suggestive of endometrial carcinoma. Simple hyperplasia with atypia was detected when ET was 11–15 mm and 16–20 mm. Complex hyperplasia without atypia was detected with ET >16–20 mm and >20 mm. Only one case had complex hyperplasia with atypia where ET was >20 mm. No abnormal endometrial pathology was detected when ET was below 11 mm. Conclusions: Increased ET on transvaginal ultrasound had association with abnormal endometrial tissue histopathology in women with HMB.

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Tuberculous meningitis (TBM) is a medical emergency. It is the most devastating manifestation of tuberculosis (TB). The outcome depends on early diagnosis and appropriate treatment. Empirical antituberculous therapy should be started if clinical suspicion is high. All patients should be tested for HIV. The choice of antituberculous drugs is extrapolated from pulmonary TB regimen, and many drugs have poor cerebrospinal fluid penetration. More evidence is required to guide on drug therapy in TBM. Steroids should be used as adjunctive therapy and response may be modulated by host genotype. Active monitoring should be done for complications such as hydrocephalus, hyponatremia, and stroke.

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The infectious etiology of periodontitis is complex. Due to its high prevalence rate, this disease has created an interest in finding a solution in the form of vaccines. Vaccination is the best known and the most important application of immunological principles to human health. The complexity of the periodontopathic bacteria might be a problem in the determination of antigens, thus complicating the development of periodontal vaccine. An attempt to review the literature on periodontal vaccine, including active immunization: Whole bacterial cells, sub-unit vaccines, synthetic peptides as antigens; passive immunization: Murine monoclonal antibodies and plantibodies; and genetic immunization: Plasmid vaccines, live, viral vector vaccines, has been done in this study.

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Evidence-based medicine (EBM) has gained acceptance as a means to improve patient outcomes. However, the practice of EBM necessitates the acquisition of certain skills beginning with the formulation of an answerable clinical question, effective search of the literature to find the best evidence, critically evaluating the evidence for its validity and the application of good evidence to patients giving due respect to their preferences and the clinician's individual expertise. Systematically analyzing the evidence is crucial to identifying the presence and degree of bias in the study, to determine the magnitude of the results in clinically relevant terms and deciding on the applicability to a particular patient. This process is termed critical appraisal. As research questions decide the appropriate study designs, the tools used for critically appraising different types of articles also vary. In general, critical appraisal of articles on therapy or intervention seek to clarify three issues – the internal validity of the study, the magnitude and precision of results, and the external validity of the study. This review aims to elucidate the practical ways in which each of these components of a critical appraisal can be approached and finally enable the clinician to use or ignore the evidence at hand. Since the acquisition of skills such as critical appraisal needs repetitive exposures and continuous constructive feedback, journal clubs offer ideal occasions where they can be initiated, pursued, and mastered. Judicious application of critical appraisal would no doubt aid the effective practice of EBM and ultimately improve patient care.

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In the quest for safer and effective anesthesia and analgesia, local anesthetics such as levobupivacaine or ropivacaine have been introduced into the clinical practice. Several studies have been done to assess their efficacy and relative superiority to bupivacaine. The aim of this review is to provide the recent and comprehensive updates regarding the clinical and pharmacological utility of levobupivacaine. Using Google search for indexing databases, a search for articles published was performed using various combinations of the following search terms: (a) Pharmacology; (b) clinical; (c) profile; (d) levobupivacaine; (e) local anesthetic; (f) recent. Additional sources were also identified by exploring the primary reference list.

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Elizabethkingia meningoseptica is a nonfermentative Gram-negative bacillus that is ubiquitously found in hospital environments, and it has been associated with various nosocomial infections. Immunocompromised individuals are particularly at increased risk for developing severe infections due to E. meningoseptica, including bacteremia. E. meningoseptica is resistant to multiple antimicrobials commonly used for Gram-negative bacteria. Rapid diagnosis and early institution of appropriate therapy for prolonged period are essential in management of such infections. We report a case of bacteremia due to E. meningoseptica in a neonate who presented with clinical findings suggestive of epidermolysis bullosa. Based on the clinical diagnosis and preliminary blood culture report, baby was started on syrup cefixime, topical fucidin cream along with fluid correction for electrolyte imbalance. As baby's general and systemic status were stable, the baby was discharged with the advice to review after 3 days. Awareness among clinicians along with correct identification by the diagnostic microbiology laboratory is required to reduce the fatal outcome associated with E. meningoseptica infections.

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Background: Preference for a male child by the family leading to a sex-selective abortion has been a leading factor for the skewed sex ratio in India. This has long-term social and demographic consequences. The present study was conducted with the aim to assess the awareness and attitudes regarding prenatal sex determination and preconception and prenatal diagnostic technique act (PC-PNDT) among females of reproductive age group (15–45 years) attending a tertiary care teaching hospital in Jammu district of J and K state in North India. Materials and Methods: A hospital-based cross-sectional study was carried out among 210 females of reproductive age group. The study participants were administered a predesigned and pretested questionnaire. Data thus obtained were analyzed using SPSS Version 20.0 and expressed in percentages. Chi-square test was used as test of statistical significance with P < 0.05 taken as statistically significant. Results: Awareness about sex determination among respondents was 94%. Higher proportion of urban respondents knew about ultrasound as the technique for sex determination than their rural counterparts (P < 0.05). Awareness regarding the PC-PNDT act and determination of sex of a child being a crime was higher among urban respondents (P < 0.05). Among the attitude, more rural females would prefer to know the sex of the child (P < 0.05) than their urban counterparts. Conclusion: Respondents had high awareness about sex determination as well as technique used for it. Awareness about PC-PNDT act was on the lower side. Education programs for the women about gender equality and wider publicity of the act in the mass media need to be scaled up.

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Background and Objective: The sonographic assessment of cervical length (CL) is an important part of ultrasound evaluation in the second trimester of pregnancy. There are specific maternal characteristics and obstetric history which affect the CL. This study aims to assess the influence of mode of delivery and ethnicity on the CL in women with divergent ethnicity. Materials and Methods: A prospective cross-sectional study was designed, including 109 pregnant Sudanese women in the second trimester. They were investigated with transvaginal ultrasonography (TVS) using high-frequency 7.5-MHz probe to assess the CL. The participants were categorized according to their ethnicity and regions. The results were analyzed using analysis of variance (ANOVA) and Student's independent t-test in the SPSS program version 16 (IBM Inc.) and P > 0.05 considered to be statistically significant. Results: The mean TVS CL was 38.2 mm in the second trimester of pregnancy. The CL of northern Sudanese women was significantly longer than women from western, southern and eastern Sudan (P = 0.041). The mean CL of previous cesarean-sectioned women was 37.7 mm which was statistically significantly shorter than those who delivered normally (P = 0.03). The CL was not significantly different in multiparous compared to nulliparous women (37.83 vs. 37.78 mm, P= 0.77). Maternal age and gestational age did not significantly change the CL in second and third trimesters, P= 0.69 and 0.99, respectively. Conclusions: In the light of this study, cesarean section and ethnicity were considered to be significant factors that affect the CL in the second trimester of pregnancy. We suggest transvaginal sonographic measurement of CL as a part of a routine ultrasound evaluation in the second trimester.

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Search for aesthetic treatment and smile enhancement has persisted in the routine of dental professionals. However, the appearance of black triangles in the anterior region compromises aesthetic looks and hampers one's self-esteem. Etiological factors for open gingival embrasures include aging, periodontal disease, loss of height of the alveolar bone relative to the interproximal contact, length of embrasure area, root angulations, interproximal contact position, and triangular-shaped crowns. Several surgical and non-surgical techniques have been proposed to treat soft tissue deformities and to manage the interproximal space. The surgical techniques aim to recontour, preserve, or reconstruct the soft tissue between the teeth. The aim of the present case report is to present a minimally invasive papillary regenerative procedure using platelet-rich fibrin membrane which was tucked into the pouch, followed by coronal displacement of the entire gingival-papillary unit.

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Introduction: Studies describing etiological distribution of tetany are rare, and awareness regarding it is poor among physicians. Our study describes different causes of tetany beyond the decrease in total serum calcium level. Methods: Patients with overt or latent tetany were evaluated clinically and from laboratory investigations. Initial investigations done were serum calcium, potassium, and arterial blood gas analysis. Both ionized and total calcium were assessed and corrected according to serum albumin level. Depending on initial reports, further tests were done such as serum phosphate, alkaline phosphatase, parathyroid hormone and magnesium levels; and urine potassium, calcium and chloride levels. Results: Gitelman's syndrome (GS), Bartter's syndrome (BS), recurrent vomiting, anxiety hyperventilation, Vitamin D₃deficiency (VDD), idiopathic hypoparathyroidism (IHP), postoperative hypoparathyroidism (PHP), acute pancreatitis, tumor lysis syndrome (TLS), and hypomagnesemia were the different causes of tetany identified. Out of 53 patients, total serum calcium was normal in 41 patients with metabolic or respiratory alkalosis (GS, BS, recurrent vomiting, and anxiety hyperventilation). Total calcium was low only in 12 patients (in VDD, IHP, PHP, acute pancreatitis, TLS, and hypomagnesemia). Ionized calcium was low in all patients. GS was the most common (38%). Recurrent vomiting (19%), anxiety hyperventilation (13%), and VDD (11%) were also common. PHP was less common (4%); acute pancreatitis, TLS, hypomagnesemia, and IHP were uncommon. Conclusion: Tetany has diverse etiologies. Both metabolic and respiratory alkalosis cause decrease in ionized calcium and are responsible for the majority of cases of tetany. Causes other than decreased total calcium should be kept in mind for early etiological diagnosis of tetany.

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Acinetobacter baumannii, an emerging nosocomial pathogen, is increasingly associated with serious infections among hospitalized patients, especially those on life-support systems. A. baumannii has become resistant to almost all currently available antibacterial agents, including carbapenems, which were once considered the drug of choice for the treatment of infections with multidrug-resistant (MDR) organisms. A. baumannii is notorious in its ability to spread among hospitalized patients and causes outbreaks which have been reported worldwide. The capability of these strains to circulate widely seems to depend on the expression of virulence factors that allow bacterial colonization as well as on the expression of antibiotic resistance. Biofilm production by A. baumannii appears to be one of the major contributing factors in colonization, notably of medical devices. This review explores published literature on the association of biofilms and MDR A. baumannii in hospitalized patients. An online search was made for articles of original work and reviews on biofilms production among Acinetobacter and their association with virulence. The articles were reviewed and results were analyzed based on biofilm production and the factors associated with it, namely biofilm cycle, biofilm-associated protein, chaperone-usher secretion system, and quorum sensing.

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Background: Hospital-acquired infections (HAIs) are a threat to public health and addressing this issue will help to plan appropriate preventive strategies. Full-fledged active HAIs surveillance is the cornerstone in assessing the burden of HAIs. This study was planned to assess the burden of HAIs by implementing a hospital-wide active surveillance system in a large tertiary care teaching hospital in south India and compare findings with those of National Health Safety Network United States (NHSN US) and International Nosocomial Infection Control Consortium (INICC) India HAI rates. Materials and Methods: Active HAIs' surveillance was initiated in 18 Intensive Care Units (ICUs) from January 2015 to September 2016. All patients admitted in the ICUs were followed up by the infection control nurses, and surveillance was done for device-associated infections (DAIs). The cumulative rates of the DAIs and device utilization (DU) rates and surgical site infection (SSI) rates were determined for all the ICUs. These data were compared with corresponding NHSN and INICC India HAI rates. Results: Total number of patient days for the entire study period was 111294, pooled mean ventilator-associated pneumonia rate was 25.00/1000 ventilator days (NHSN US 2.0 and INICC India 9.4); Pooled mean central line-associated blood stream infection rate was 7.2/1000 central line days (NHSN US 1.1 and INICC India 5.1). The pooled mean ICU catheter-associated urinary tract infection rate was 6.1/1000 catheter days (2.1 NHSN US and 2.9 INICC India). The pooled mean SSI rate was found to be 3.5/100 surgeries. The DU rates had a significant positive agreement with the DAI rates. The DAI rates of most of the ICUs were found be to be higher than NHSN US and INICC India rates. Conclusion: There is an increasing need to implement an active surveillance system to detect and monitor the HAI rates which would be vital to implement infection control measures in a proactive manner rather than reactive.

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Esthetic awareness has improved vastly in the last decade. Periodontal plastic surgery has made it possible to correct or eliminate anatomic, developmental, or traumatic deformities of the gingiva or alveolar mucosa. However, till date, the most challenging scenario lies in the enhancement of lost interdental papillae in the maxillary anterior region. An open gingival embrasure or black triangle occurs as a result of a deficiency of papilla beneath the contact point, which causes complex esthetic and functional problems. Several reasons contribute to the loss of interdental papillae, and various surgical and nonsurgical techniques for papillary reconstruction have been proposed till now. The present article describes a case of papilla reconstruction procedure using connective tissue graft. The procedure resulted in nearly 100% fill of the interproximal embrasure.

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