Background: Long lasting insecticide net (LLIN) is one of the major tools utilized in the control and prevention of malaria across all age groups. Aim: This study compared the accessibility and usage patterns of LLIN in rural communities of Odeda and Imeko-Afon local government areas (LGAs). Materials and Methods: Three villages were selected each from Odeda and Imeko-Afon LGAs using the simple random sampling method. Questionnaires were administered to the head of households, and personal information was collected from individual member of the family. Descriptive analysis was used to summarize important variables. Results: A total of 140 households participated in the study, 70 from each LGA. Of the households surveyed, 87.1% have LLIN in Imeko-Afon LGA and was significantly higher (P = 0.0000) compared to 60% in Odeda LGA (P = 0.000). However, 96.7% and 95.2% of households in Imeko-Afon and Odeda LGAs respectively acquired the LLIN free from the government. The utilization rate by househeads the night prior the study was 72.1% and 57.1% in Imeko-Afon and Odeda LGA respectively (P = 0.115). Of the total respondents, only 47.9% in Imeko-Afon and 32.4% in Odeda sleep under the net everyday (P = 0.000) and 22.9% and 62.1% respectively in both LGAs do not sleep under LLIN (P = 0.000). There was a significant difference (P = 0.000) in the number of respondents that sleep under LLIN every day between the two LGAs. Reason for not sleeping under net was majorly heat. Conclusion: There is a need for more awareness and health education on proper utilization and maintenance of LLIN to enhance the effectiveness of the net.

Purpose: Bacterial vaginosis is the most common type of vaginal infection among women of reproductive age and accounted for at least one-third of all vulvovaginal infections. The main aim of this prospective study was to determine the risk factors that may be associated with the occurrence of bacterial vaginosis among the reproductive age group females in Assam. Materials and Methods: A total of two hundred married, nonpregnant females in the reproductive age group who complained of one or more symptoms suggesting lower genital tract infection were enrolled in this study. Detailed history of the patients was taken. Three high vaginal swabs were obtained after informed consent of the patients. Bacterial vaginosis was diagnosed on the basis of Amsel's clinical criteria and Nugent's Gram stain scoring method. Data was statistically analyzed using Chi-square test. Results: Our study found prevalence of bacterial vaginosis to be 51.5% (103/200) by Amsel's criteria and 49% (98/200) by Nugent's criteria respectively. Significant association was found between bacterial vaginosis and age, socioeconomic status, parity and contraceptives. However, no significant association was found between duration of marriage and stage of the menstrual cycle. Conclusion: A relatively higher prevalence rate of bacterial vaginosis was found in the population under study, which may be attributed to factors like low socioeconomic status and unhygienic practices. Barrier contraception was found to be an effective method for prevention of transmission of bacterial vaginosis. However, more studies may be needed to confirm and evaluate the causes of these associations, so that a preventive strategy can be planned.

Background: Healthcare workers (HCWs) have a high risk of hepatitis B virus (HBV) infection. The prevalence of HBV among HCWs in hospitals in developing countries is high. However, the vaccination status of these workers in hospitals in Haldwani city is not well documented. Objectives: The aim was to assess the hepatitis B vaccination status among HCWs in a tertiary care hospital in Haldwani city of Nainital, Uttarakhand, India. Materials and Methods: In this cross-sectional study, 367 HCWs were randomly selected. Information pertaining to demographic and vaccination status was collected by interviewing them with the help of predesigned and pretested interview schedule. Result: The overall proportions of complete, incomplete and unvaccinated respondents with hepatitis B vaccine were 48.5%, 21.8%, and 29.7% respectively. In relation to designation of respondents, 35 (53.8%), 65 (77.4%), 61 (51.7%), 12 (40.0%) and 5 (7.2%) of respondents who were residents, interns, nurses, technicians and nursing attendants respectively had received Hepatitis B vaccination as against those who had partially received and not received vaccination and this differences were statistically significant. The most common reason for acceptance of vaccine was protection against Hepatitis-B infection (39.9%) and the commonest reason for not getting vaccinated was negligence (43.1%) Conclusion: These results conclude that because of low immunization coverage, HCWs are at greater risk of getting Hepatitis B infection at the hospital.

Background: Maxillofacial fractures are common following trauma and show varying epidemiology and demographics. Aims: To describe the pattern of maxillofacial fractures outlining the etiological spectrum, fracture characteristics and treatment outcomes in our local setting. Settings and Design: This descriptive retrospective study was conducted at the Plastic Surgery Department, of our Institute in Pondicherry from January 1, 2007 to December 31, 2013. Materials and Methods: All adult and pediatric patients presenting with confirmed maxillofacial fractures were included. Results: A total number of 432 patients with 656 facial fractures presented during the study period. Male to female ratio was 10:1. Road traffic accidents (87.9%) were the most common mode of injury with Orbitozygomatic fractures predominating (55.7%). Associated injuries were observed in 30.3% of patient's. 66.2% of patients were operated, and 33.8% were treated conservatively. Conclusion: Increasing awareness and improved legislation are required to combat the trend of increased maxillofacial fractures.

Background: Antimicrobial resistance mechanisms including the beta-lactamases (βLs) such as extended-spectrum beta-lactamases (ESBLs), AmpC βLs, metallo-beta-lactamases (MBLs) and inhibitor-resistant TEM βLs (IRTs) are continuously developing, and infections due to such resistance bacteria are left with limited treatment options. Aims: This study was conducted to evaluate the activity of different beta-lactams and non-beta-lactam antibiotics against βL producing Gram-negative clinical isolates. Materials and Methods: Isolation, identification of different βLs and antibiotic susceptibility testing in 350 non-repeat, consecutive, Gram-negative clinical isolates were performed using the automated Vitek 2 system (bioMe΄rieux, Marcy l'Etoile, France). Eighteen antimicrobials were included in the AST N-280 panel of Vitek 2. Phenotypic disk diffusion methods were also employed for the detection of various βLs. Result: Both the automated and phenotypic methods identified 34% (119/350) βLs of which 18.29%, 6%, 1.14%, 2.86%, 3.42%, and 1.43% were ESBLs, AmpC βLs, MBLs, ESBL with AmpC, ESBL with MBL and AmpC with MBL, respectively. IRTS were detected in 3 (0.86%) isolates. Among the β-lactams and β-lactams with βL inhibitors, the least resistant antimicrobials against βLs were respectively cefepime (73%) and pipercillin/tazobactam (45.5%). Regarding the non-beta-lactams, maximum sensitivity was observed with colistin (96.4%), followed by tigecycline (94%), meropenem (87.4%), amikacin (86.6%) and ertapenem or imipenem (82.4%). The activity of nitrofurantoin was relatively good with a sensitivity of 61.4%. Conclusion: In our setting, colistin, tigecycline and meropenem turned out to be the best available antimicrobials to tackle the infections caused by βLs. Nitrofurantoin could be used in the management of urinary tract infection caused by multidrug-resistant isolates if its activity is high enough.

Introduction: Toxoplasma gondii; is extreme zoonotic intracellular protozoan, exceeding human medical impact due congenital and cerebral toxoplasmosis. Diabetes is characterized by hyperglycemia resulting from perturbation in insulin secretion, insulin action or both, possible through its long depilating term to flare up the intrinsic (latent) stage of T. gondii. Objective: Is focused on studying the latent toxoplasmosis, based on identifying levels of both average brain parasite load and immunoglobulin titers in diabetic induced rat. Materials and Methods: A total number of 60 Wistar male rats (120-180 g) were divided into four groups, 15 each and experimented as follow; un-infected-normoglycaemic, un-infected-diabetic, infected-normoglycaemic and infected-diabetic groups. Blood samples were taken from rats for glucose determination and for serological assay, and at the same time brain tissue samples for parasite load estimation were collected from three sacrificed rats in each group at sequence days; 1, 15, 30, 45 and 60 cycle to days post diabetes, with the same compatible days at 45, 60, 75, 90 and 105 corresponding to days post infection. Results: Showed significance higher in both blood glucose levels and in cysts number in infected diabetic group than the uninfected-diabetic one. The elevated brain parasite load and IgM titer were always exceeding higher progression all over the course and parallel to the elevated glucose levels in infected diabetic group. Conclusion: Hyperglycemic factor was confirmed to opportunist higher T. gondii brain parasite load and elevate immunoglobulin titer in latent infected and diabetes induced rat, possible match with T. gondii sero-positive diabetic patient, and reflects the importance of serological monitoring in particular uncontrolled hyperglycemic ones.

Context: Patient satisfaction is a determinant of treatment uptake and adherence to Directly Observed Treatment Short course (DOTS) therapy for Tuberculosis (TB). Waiting time, staff's attitude and improvement in symptoms may affect patient's satisfaction. Aims: The rationale of the present study is to assess the levels of satisfaction among patients utilizing the DOTS services and the factors contributing toward patient satisfaction. Settings and Design: Cross-sectional study. Study Duration: Jan 2009 to March 2009. Study Area: Four Designated Microscopic Centers (DMCs) of District Jhansi. Materials and Methods: Exit interviews of all the patients who were diagnosed as TB cases and put on DOTS in the first quarter of 2009 (i.e., subjects registered from 1 ^st January 2009 to 31 ^st March 2009) at four selected DMCs were taken on pre-tested questionnaire. Statistical Analysis: Results are expressed in percentages. Results: Average waiting time at center reported was 5-10 minutes by majority of cases (42.7%). Approx.78.6% patients were fully satisfied with the services provided at the centers. Lack of financial burden was the most common reason for satisfaction (95.4%), followed by improvement in symptoms (75%). Most common problems faced by the patients was difficult in coming on alternate days (30.0%) followed by loss of wages and transport charges (26.8%). Conclusion: The study findings could potentially be explored to improve DOTS services to attain maximum satisfaction among TB patients.

Introduction: Chronic suppurative otitis media (CSOM) is defined as infection of the middle ear that lasts for >3 months and is accompanied by tympanic membrane perforation. The incidence is higher in developing countries, especially among the low socioeconomic strata of the society. Many authors have focused their attention on the bacterial flora of CSOM, but very little is known about the mycological aspects of these, the importance of which has been increasing in the recent years. Objective: The present study was aimed to speculate the etiological fungal flora responsible for the cases of CSOM among patients who attended the Ear, Nose, and Throat Department of our hospital a tertiary care center in Uttarakhand. Materials and Methods: The total of 107 patients (both males and females) who were clinically diagnosed with CSOM and were on any antibiotics (oral, topical or systemic) for >14 days and still persisted with symptoms were included in this study. Results: Among the 107 cases of CSOM studied, fungi were isolated in 83 (77.57%). Majority of the patients were in second and third decades of life (62.62%). Of the 83 fungal culture positive cases, the predominantly isolated fungi were Aspergillus species (47%), Candida species (41%), and Penicillium species (9.6%). Among the Aspergillus, the predominant species were Aspergillus flavus (17 isolates) and Aspergillus niger (12 isolates). Candida albicans (19 isolates) and Candida tropicalis (9 isolates) were the commonly isolated species of Candida. Conclusion: A definite search for fungal etiology is desirable in all cases of CSOM. Prolonged use of topical antibiotics or antibiotics-steroids ear drops may cause suppression of bacterial flora and the subsequent emergence of fungal flora. This probably increases the incidence of fungal superinfection. Otologists should suspect mycotic otitis media in patients with continuous otorrhea and who do not respond to the antibacterial treatment.

Background: Defaulters are producing the challenging, daunting category of drug resistant cases. It is important to examine and understand the patient's notions and terms to manage them effectively. Objective: To study the reasons behind failure of adherence to treatment and to assess the health care seeking behaviour with awareness of these patients regarding the public sector provisions. Materials and Methods: In depth interviews with ten patients who had defaulted and were undergoing CAT-II treatment which included both retreatment defaulters and new defaulters, were conducted by repeated contacts in Fatehpur Beri PHC DOTS centre. Results: People refuse to seek treatment from a government health centre when they fall sick seriously as they are ready to get treated at any expense and seek private health care facility for the prompt treatment. There is a notion that free service from public sector is not as effective as private corporate hospitals. In the public sector patients defaulted because of side effects of drugs, fear of getting admitted in big tuberculosis (TB) hospitals, incompatible timing, neglect, long waiting time, TB deaths in the family and lack of family support. Among migrants, lack of employers support, family support forced them to return home. Ignorance about existence of DOTS centre with free treatment was observed. Most of the patients were unaware that incomplete treatment could lead to disease. Misconceptions observed were that treatment was futile (talk in the community about drugs being useless) and most of the patients were afraid of the disease and thought they could die because of it. Conclusion: Proposed measures include: Recognition of traditional medicine/complementary alternative medicine practitioners for universal access to TB diagnosis and care, Public sector should be made attractive to the middle class society through enhancement of services and user fees and empowerment initiatives for lack of social support of the migrants.

Aim: Urinary tract infections (UTIs) are among the most common human infections with distribution of causative agents and their susceptibility pattern to antibiotics varying from region to region. This study aimed at determining the bacterial uropathogens and their antibiotic resistance profile among patients in a Nigerian tertiary health care facility. Materials and Methods: Appropriate urine specimens (midstream/catheter specimen urine) of all suspected cases of UTI by clinicians were processed in the medical microbiology laboratory for detection of significant bacteriuria. Bacteria uropathogens isolated were identified by standard biochemical tests and antibiotic susceptibility test to eight antibiotics was carried out on them using Kirby-Bauer disc diffusion technique. Methicillin-resistant Staphylococcus aureus (MRSA) was identified by cefoxitin disc diffusion technique and extended-spectrum beta-lactamase (ESBL) producing enterobacteria were detected using double-disc synergy test. Results: Of the total 157 males and 189 females investigated, 35.7% and 66.1% respectively had significant bacteriuria. Escherichia coli was the most commonly isolated bacterial pathogen both among in- and out-patients (52.6% vs. 65.5%). Other isolated organisms were S. aureus (13.4% vs. 19.0%), Pseudomonas aeruginosa (10.3% vs. 2.4%), Klebsiella pneumoniae (7.2% vs. 7.1%) and K. aerogenes (7.2% vs. 1.2%). Resistance rate of uropathogens to antibiotics was higher among in-patients. Resistance rate to ofloxacin, ceftazidime and ceftriaxone was generally very low compared to other tested antibiotics. Multiple resistant bacteria: MRSA and ESBL-producing enterobacteria were detected among both in-and out-patient with no significant difference in isolation rate. Conclusion: There is a need for continuous monitoring of uropathogens and their antibiotic sensitivity profile for evidence-based empirical treatment of UTI. There is an urgent need for the establishment of antibiotic stewardship programs in healthcare facilities in Nigeria.

Poisoning with chromium is fatal and rarely reported. We report a case of a 25-year-old man who developed severe acidosis, gastrointestinal hemorrhage, acute kidney, and hepatic injury following homicidal ingestion of chromium. Patient improved after multiple cycles of alternate day hemodialysis.

The highest percentages of tribes are living in North East region of India and in Madhya Pradesh in the central India. This study is based on the NSSO 60 ^th round data, with the two objectives - Tribal's ailing and hospitalization pattern and treatment seeking behavior of ailing Madhya Pradesh and India. Result shows that around 7% of Indian tribes were ailing 15 days before the survey and about 10% of them were hospitalized during 365 days before the survey. Rural tribes were more ailing and went to hospital for treatment than urban tribes. Odds ratio show that rural, male, old-aged, educated up to primary, not in labor force, currently married, and Hindu tribes were more likely to be hospitalized in Madhya Pradesh. Odds ratio also depicts that the household that have no drainage, used water from tube well and hand pump were more likely to be ailing.